Comparative Effectiveness of Metformin Dosage Uptitration Versus Adding Another Antihyperglycemic Medication on Glycemic Control in Type 2 Diabetes Patients Failing Initial Metformin Monotherapy: A Retrospective Cohort Study.

Metformin is recommended as first-line treatment for type 2 diabetes (T2D). A disadvantage of metformin is the possibility of gastrointestinal adverse effects in some patients. Many T2D patients are not able to achieve/maintain glycemic control from initial metformin treatment and receive treatment intensification by means of metformin dosage uptitration or addition of a T2D drug.

Whole Genome Sequencing detects Inter-Facility Transmission of Carbapenem-resistant Klebsiella pneumoniae.

Objectives: To identify transmission patterns of Carbapenem-resistant Klebsiella pneumoniae infection during an outbreak at a large, tertiary care hospital and to detect whether the outbreak organisms spread to other facilities in the integrated healthcare network.

Methods: We analyzed 71 K. pneumoniae whole genome sequences collected from clinical specimens before, during and after the outbreak and reviewed corresponding patient medical records.

Traditional Risk Indices as Predictors of Future Utilization and Charges in the Context of Population Health for an Uninsured Cohort.

Introduction: The uninsured population presents unique challenges to the application of an integrated approach to population health. Our objective is to compare and test population risk indices for identifying a cohort of uninsured patients at high-risk for avoidable healthcare utilization and costs.

Methods: Patients who had a least one visit at a safety-net clinic, had a primary address in Mecklenburg County, were aged 18-74, and had the most recent healthcare visit coded as 'uninsured' were identified in the baseline period.

Impact of Timely Treatment Intensification on Glycemic Goal Achievement in Patients With Type 2 Diabetes Failing Metformin Monotherapy.

Purpose The purpose of the study was to examine the association between timely treatment intensification (TTI) and glycemic goal achievement in patients with type 2 diabetes (T2D) failing metformin monotherapy (MM). Methods This study was set at a large integrated health care system in the United States. The study cohort included T2D patients aged 18 to 85 years who were on MM between January 2009 and September 2013 and had an uncontrolled glycated hemoglobin (A1C) reading (≥8%) after at least 3 months of MM (corresponding date was index date).

Patient and Provider Factors Affecting Clinical Inertia in Patients With Type 2 Diabetes on Metformin Monotherapy.

Purpose: Our aim was to determine the extent of clinical inertia and the associated patient and provider factors in patients with type 2 diabetes on metformin monotherapy (MM) at a large integrated health care system in the United States.

Methods: The study cohort included patients with type 2 diabetes aged 18 to 85 years, on MM between January 2009 and September 2013, who experienced MM failure (had an uncontrolled glycosylated hemoglobin [HbA] reading (≥8.0% [64 mmol/mol]) after at least 90 days of MM).