Appendices

Appendix 1 – Baseline Characteristics

Covariate / Definition*
Age
Sex
Race
Baseline year
Total N distinct oral anti-diabetic agents prescribed in past 180 days
Comorbidity score, Charlson
N distinct generics
N physician visits
Hospitalization (Y/N)
Visit to endocrinologist (if we have specialty)
Depression / 293.83, 296.2x, 296.3x, 296.90, 298.0x, 300.4x, 309.0x, 309.1x, 309.28, 311
Renal impairment / 585.x
Hypertension / 401.xx-405.xx
Hypercholesterolemia / 272.0, 272.4, 272.9
Congestive heart failure / Inpatient hospitalization with 428.xx as the primary diagnosis
Coronary atherosclerosis / 414.0x
Cardiac dysrhythmia / 427.xx, exclude 427.5
Stroke and/or transient ischemic attack / Inpatient hospitalization with diagnosis in any position of: 430.x, 431.x, 433.x1,
434.x (exclude 434.x0), 436.x
Transient ischemic attack: 435.x
Peripheral vascular disease / 433.9, 433.90, and 433.91, 433.30, 433.31, 433.8, 433.80, 433.81
Ischemic heart disease / Any of the following drugs, procedures, or diagnoses
MI: ICD-9 dx: 410, 412, DRG: 121, 122, 123
PTCA (CPT-4: 92982, 92995, 92997, 92982-92984, ICD-9 proc: 00.66, 36.03, 36.09, DRG: 112, 555)
Stent (CPT-4: 92980, 92981, ICD-9: 36.06, 36.07, DRG: 556, 557,558)
CABG surgery (CPT-4: 33510 – 33545, ICD-9: 36.1x, 36.2x, DRG: 106, 107, 109, 547, 548, 549, 550)

Angina: 411.x, 413.x

nitroglycerin prescription
Hyperglycemia / 790.29
Diabetic ketoacidosis / 250.1x
Hyperosmolar hyperglycemic nonketotic syndrome (HONK) / 250.2x
Diabetes with coma / 250.3x, excluding 250.30
Hypoglycemic coma / 251.0, 250.30
Hypoglycemia / 251.1, 251.20, 962.30, 775.60
Also, 250.8x as long as none of the following codes are co-diagnoses: 259.8, 272.7, 681.xx, 682.xx, 686.9x, 707.xx, 709.3, 730.0-730.2, 731.8
Diabetic retinopathy / 362.01-362.07
Macular edema / 362.8
Diabetic nephropathy / 583.81
Pyelonephritis/infections of kidney / 590.xx
End-stage renal disease / ICD-9 diagnosis: 585.6
Diabetic neuropathy / 250.6, 357.2
Amputation / ICD-9 diagnosis: V49.7x – lower limb amputation status, V52.1 – artificial leg
ICD-9 procedure: 84.1x
CPT: 26910, 27290, 27295, 27590 – 27598, 27803, 27880-27889, 28800, 28804, 28805, 28810, 28820, 28825
Gastroparesis / 536.3
Diabetic foot / 707.1x (ulcer of lower limbs)
Osteoporosis / 733.0x
Hypertensive chronic kidney disease / 403.xx – 404.xx
Chronic kidney disease / 585.xx
Skin infections / 680.xx-686.xx
Skin ulcer / 682.xx
Erectile dysfunction / 607.84
Urinary tract infection / 599.0
Atherosclerosis of extremity with ulceration / 440.23

*unless otherwise noted, clinical conditions are defined based on the presence of an inpatient or outpatient diagnosis in any position

Appendix 2 – Diabetes Medications

Oral anti-diabetic agents

Biguanides

metformin

Alpha-glucosidase inhibitors

acarbose

miglitol

Thiazolidinediones

pioglitazone

rosiglitazone

Meglitinides

nateglinide

repaglinide

Sulfonylureas

chlorpropamide

tolazamide

tolbutamide

glipizide

gliclazide

glimepiride

glyburide

Dipeptidyl peptidase-4 inhibitors

saxagliptin

sitagliptin

linagliptin

Non-insulininjected agents

Glucagon-like peptide 1 (GLP-1) analog

exenatide

liraglutide

Amylinanalog

pramlintide

Basal insulin

insulin human isophane (NPH)

insulin human zinc

insulin human zinc, extended

insulindetemir

insulinglargine, recombinant

Insulin mixtures

insulin human isophane (NPH)/insulin human regular

insulinlispro/insulin lispro protamine

insulinaspart/insulin aspart protamine

Mealtime Insulin

insulinaspart, recombinant

insulinglulisine

insulinlispro, recombinant

insulin human regular

insulin human regular, buffered

Appendix 3– Treatment intensification patterns following a 30 day insulin initiation phase.

Changes in medication use during intensification phase
Insulin Regimen During Initiation Phase / N / Increase in insulin dose / frequency / Additions to treatment regimen / Discontinue insulin
Basal / Mixed / Mealtime / Mealtime insulin / Mixed insulin
Basal only / 3,641 / 910 (25.0) / -- / -- / 377 (10.4) / 96 (2.6) / 938 (25.8)
Mixed only / 897 / -- / 226 (25.2) / -- / -- / -- / 238 (26.5)
Basal + mealtime / 1,051 / 211 (20.1) / -- / 211 (20.1) / -- / -- / 296 (28.2)
Total / 5,589 / -- / -- / -- / -- / -- / 1,472 (26.3)