OBJECTIVE: This study describes the clinical management of type 2 diabetes among a cohort of patients receiving oral antidiabetic monotherapy. STUDY DESIGN AND SETTING: A retrospective study was conducted within an integrated Midwestern health system that included all individuals receiving oral antidiabetic monotherapy during the period June 1, 1999 to November 30, 2002 (n = 9335). Among patients with elevated hemoglobin A(1c) (HbA(1c)) test result(s), Kaplan-Meier estimates of median time until pharmacotherapy change were calculated. RESULTS: Among the 8068 patients who had > or = 1 HbA(1c) measurement during the study period, 21.4% were at goal (i.e. HbA(1c) < 7%). Among patients with at least one elevated test result (> or = 7%), the median time topharmacotherapy change following an HbA(1c) test result of between 7-10% was just over 1 year (372 days, 95% confidence interval [CI] 358-393 days) and 160 days for patients with HbA(1c) > 10%. Among patients with at least two elevated tests, the median time to pharmacotherapy change was 275 days from the second test result of between 7-10%, and 70 days among patients with a second HbA(1c) > 10%. The median time between HbA(1c) testing was 166 days overall, and 154 days among patients with at least one elevated result. CONCLUSION: Despite the known benefits of glycemic control among patients with diabetes, the time betweenelevated HbA(1c) results and pharmacotherapy change exceeds 12 months for those with HbA(1c) test resultsbetween 7-10% and 9 months for those with results over 10%.
