Managed Care - February 2009 - (Page 44) nificantly poorer HbA1c control. One interpretation for this result is that patients and physicians may be attempting to avoid insulin therapy by using a variety of newer oral agents. The lack of a relationship between HEDIS score and percentage of diabetes prescriptions in the lowest copay tier may be due to the fact that the copay tier status was missing for many products. The initial assumption was that a higher percentage of prescriptions in the lowest copay tier might result in better patient compliance and therefore better HbA1c control. Although this proved to be the case directionally, the results did not reach statistical significance. We calculated the percentage of prescriptions in the lowest copay tier based only on the product prescriptions for which a copay tier was known. Although the results clearly indicate that higher utilization of analog insulin is associated with greater HbA1c control in diabetes patients in commercial health plans, an association does not imply a cause-andeffect relationship. Drug therapy is only one factor in the management of diabetes. Comprehensive diabetes care may also entail enrollment in disease management programs, improved adherence to published treatment guidelines, and other factors such as diet and exercise. A potential confounding factor could be the proportion of Type 1 diabetes patients in a health plan.These patients would raise the ratio of insulin to oral medications, but not necessarily the analog portion. While Type 1 patients would be expected to be more adherent to their regimens, they might not show any better control than Type 2 patients because of the volatility of their glucose levels. Type 1 patients represent only 5 percent to 10 percent of diabetes patients, and therefore the impact on the correlation between insulin utilization and improved HEDIS scores is likely to be small. Also, there is no reason to expect significant fluctua- tions in the portion of Type 1 and Type 2 patients among health plans. Therefore, the proportion of Type 1 patients would not be expected to be a significant factor in these results. No data were available in this study to determine concomitant use of insulin and oral products, or among products within a drug class.The prescription share analysis assumes patients are on monotherapy, although concomitant use would not invalidate the findings regarding the relationship between HEDIS scores and analog insulin prescription share. The new NCQA measure of percentage of patients with diabetes with good HbA1c control ( 9 percent. Human insulin showed either a weaker positive effect (univariate analysis) or a negative effect (multivariate analysis) on 44 MANAGED CARE / FEBRUARY 2009 http://www.ahrq.gov/qual/nhqr05/nhqr05.htm http://www.ahrq.gov/qual/nhqr05/nhqr05.htm http://www.ncqa.org/tabid/362/Default.aspx http://www.ncqa.org/tabid/362/Default.aspx http://www.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_07.pdf http://www.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_07.pdf http://www.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_07.pdf http://www.ncqa.org/tabid/177/Default.aspx http://www.ncqa.org/tabid/177/Default.aspx http://www.ncqa.org/tabid/65/Default.aspx http://www.ncqa.org/tabid/65/Default.aspx
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