1062-P: Attainment of Glycemic Targets among Adults with Diabetes in Canada: A Cross-Sectional National Diabetes Repository Study
Bibliographic record
Abstract
Objective: International societies and clinical practice guidelines recommend a Hemoglobin A1c target of ≤7.0% for the majority of adults with type 1 (T1D) and type 2 diabetes (T2D). However, the proportion meeting this target and its predictors have not been comprehensively described outside of the USA or in population-based data sources. Methods: Adults with diabetes were identified in the National Diabetes Repository, a primary care electronic medical record (EMR) database from 5 Canadian provinces, from January 2015 to June 2019. Individuals were categorized as T1D (using a previously validated algorithm), T2D not prescribed insulin, or T2D prescribed insulin. Using the most recent HbA1c, proportions of individuals with HbA1c ≤7.0% were determined and compared using Chi-square tests. Multivariable logistic regression models were used to assess the association between predictors and meeting the HbA1c target. Results: Of 83,273 eligible adults in the National Diabetes Repository, 1484 had T1D, 10,473 had T2D prescribed insulin and 71,316 had T2D not prescribed insulin. Proportions meeting the HbA1c target of ≤7.0% were 23.9%, 24.9%, and 62.4%, respectively (p=0.4 for T1D vs. T2D prescribed insulin, p<0.0001 for other comparisons). In multivariable logistic regression models, depression was associated with reduced likelihood of meeting the HbA1c target for T1D (OR 0.74, 95% CI 0.55-0.98). Male sex, lower income quintile, and insulin use were associated with reduced likelihood of meeting the HbA1c target for T2D (0.85(0.83-0.88); 0.83(0.79-0.88); 0.23(0.22-0.24)). Conclusions: In a Canadian population-based primary-care EMR database, less than one-fourth of adults with T1D and T2D prescribed insulin, whereas two-thirds of adults with T2D not prescribed insulin, attain the recommended HbA1c target of ≤7.0%. Further research and implementation approaches are required to optimize outcomes in diabetes, particularly for those requiring insulin. Disclosure A. Weisman: None. B. A. Perkins: Advisory Panel; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Insulet Corporation, Novo Nordisk Canada Inc., Other Relationship; Self; Abbott Diabetes, Medtronic, Novo Nordisk Canada Inc. Funding Diabetes Action Canada
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".