Detecting Secular Trends in Clinical Treatment through Temporal Analysis.

Area of Science:

• Health Services Research
• Clinical Epidemiology
• Health Informatics

Background:

• Medical treatments and practice patterns evolve due to new evidence, guidelines, and market influences.
• Monitoring these secular trends is crucial for evaluating evidence-based practice and outcomes research.
• The Veterans Health Administration (VHA) provides a robust dataset for analyzing national clinical trends.

Purpose of the Study:

• To analyze changes in the prevalence of diseases, medications, and procedures within the VHA from 2001 to 2014.
• To identify significant secular trends, particularly those related to diabetes mellitus type II (DM2).
• To assess shifts in diagnostic testing and therapeutic agent utilization for DM2.

Main Methods:

• Utilized a large national clinical dataset from the United States Veterans Health Administration (VHA).
• Measured annual changes in the prevalence of diseases, medications, and procedures from 2001 to 2014.
• Employed a generalized linear model to assess statistical significance of observed trends.

Main Results:

• Observed numerous significant secular trends across various clinical areas.
• Diabetes mellitus type II (DM2) prevalence increased post-2001, plateauing around 2008.
• Glycosylated hemoglobin testing increased, while general glucose testing decreased; insulin and metformin use rose, contrasting with sharp declines in glyburide and rosiglitazone use.

Conclusions:

• Secular trends in medical treatments show dynamic changes, particularly evident in DM2 management.
• Treatment patterns for DM2 have shifted towards increased use of metformin and insulin, alongside changes in diagnostic testing.
• Analysis of large clinical datasets effectively captures evolving healthcare practices and treatment efficacy over time.