Evidence map›Paper›PMID 38160431›Full record

ArticleJournal of endocrinological investigation2024

A machine learning model to predict therapeutic inertia in type 2 diabetes using electronic health record data.

C C McDaniel, W-H Lo-Ciganic, J Huang, C Chou

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Article in Journal of endocrinological investigation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

4 authors.

C C McDanielDepartment of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA. cnc0027@auburn.edu.ORCID http://orcid.org/0000-0001-6053-036X
W-H Lo-CiganicDepartment of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
J HuangDepartment of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
C ChouDepartment of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.

Funding

American Foundation for Pharmaceutical Education Pre-Doctoral FellowshipPharmaceutical Research and Manufacturers of America Foun Pre-Doctoral Fellowship
6 · The paper itself

Abstract

objectiveTo estimate the therapeutic inertia prevalence for patients with type 2 diabetes, develop and validate a machine learning model predicting therapeutic inertia, and determine the added predictive value of area-level social determinants of health (SDOH).

methodsThis prognostic study with a retrospective cohort design used OneFlorida data (linked electronic health records (EHRs) from 1240 practices/clinics in Florida). The study cohort included adults (aged ≥ 18) with type 2 diabetes, HbA1C ≥ 7% (53 mmol/mol), ≥one ambulatory visit, and ≥one antihyperglycemic medication prescribed (excluded patients prescribed insulin before HbA1C). The outcome was therapeutic inertia, defined as absence of treatment intensification within six months after HbA1C ≥ 7% (53 mmol/mol). The predictors were patient, provider, and healthcare system factors. Machine learning methods included gradient boosting machines (GBM), random forests (RF), elastic net (EN), and least absolute shrinkage and selection operator (LASSO). The DeLong test compared the discriminative ability (represented by C-statistics) between models.

resultsThe cohort included 31,087 patients with type 2 diabetes (mean age = 58.89 (SD = 13.27) years, 50.50% male, 58.89% White). The therapeutic inertia prevalence was 39.80% among the 68,445 records. GBM outperformed (C-statistic from testing sample = 0.84, 95% CI = 0.83-0.84) RF (C-statistic = 0.80, 95% CI = 0.79-0.80), EN (C-statistic = 0.80, 95% CI = 0.80-0.81), and LASSO (C-statistic = 0.80, 95% CI = 0.80-0.81), p < 0.05. Area-level SDOH significantly increased the discriminative ability versus models without SDOH (C-statistic for GBM = 0.84, 95% CI = 0.84-0.85 vs. 0.84, 95% CI = 0.83-0.84), p < 0.05.

conclusionsUsing EHRs of patients with type 2 diabetes from a large state, machine learning predicted therapeutic inertia (prevalence = 40%). The model's ability to predict patients at high risk of therapeutic inertia is clinically applicable to diabetes care.

Indexed as

Diabetes Mellitus, Type 2Electronic Health RecordsHypoglycemic AgentsMachine LearningAdultAgedFemaleGlycated HemoglobinHumansMaleMiddle AgedPrognosisRetrospective StudiesGlycated HemoglobinHypoglycemic AgentsMachine learningPrescribing behaviorsSocial determinants of healthTherapeutic inertiaTreatment intensificationType 2 diabetes

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.