{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:49:41Z","timestamp":1791434981180,"version":"4.3.3"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To estimate the proportion of older patients with type 2 diabetes (T2D) and HbA1c above or below goal at provider level and explore factors associated with patients being above or below goal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We used 2023 Cleveland Clinic electronic health records, including patients \u2265\u200965\u2009years old with T2D, \u2265\u20091 diabetes medication and \u2265\u20091 HbA1c measurement. Patients were assigned to their listed primary care provider or the one they saw most frequently and stratified into good, intermediate, or poor health. Outcomes were patients being above, at, and below goal, defined as HbA1c greater than, 0%\u20131.5% lower than, and \u2265\u20091.5% lower than goal, respectively. HbA1c goals were &lt;\u20097.5% for patients with good, &lt;\u20098% intermediate and &lt;\u20099% poor health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 406 providers and 15\u2009865 patients. Across providers, 52.1% (range: 10%\u201387.9%) of patients were below goal (13.4% in those with good, 42.0% intermediate, 76.0% poor health); 11.3% (range: 0.0%\u201336.4%) were above goal (25.1% in those with good, 13.7% intermediate, 6.7% poor health). There was significant variation across providers (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In a multivariable model, having endocrinology providers (vs. internal medicine) decreased the adjusted relative risk ratio (aRRR) of being below goal (aRRR\u2009=\u20090.69; 95% CI: 0.57\u20130.82) and increased the probability of being above goal (aRRR\u2009=\u20091.65; 95% CI: 1.33\u20132.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Substantial provider\u2010level variation suggests that individualised glycemic management for older adults remains difficult to operationalise in routine care. Clinical decision support tools that automate assessment of health status and recommend glycemic goals may help clinicians better align glycemic management with patient needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71178","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:51:31Z","timestamp":1787550691000},"page":"10370-10378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in Treatment Patterns of Type 2 Diabetes in Older Patients"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4788-773X","authenticated-orcid":false,"given":"Phuc","family":"Le","sequence":"first","affiliation":[{"name":"Center for Value\u2010Based Care Research Primary Care Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic Research Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Misra\u2010Hebert","sequence":"additional","affiliation":[{"name":"Center for Value\u2010Based Care Research Primary Care Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Healthcare Delivery and Implementation Science Center Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Boyer","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic Research Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3897-4551","authenticated-orcid":false,"given":"Kevin M.","family":"Pantalone","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic Research Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Department of Endocrinology Medical Specialty Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1627-9777","authenticated-orcid":false,"given":"Hamlet","family":"Gasoyan","sequence":"additional","affiliation":[{"name":"Center for Value\u2010Based Care Research Primary Care Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Casacchia","sequence":"additional","affiliation":[{"name":"Center for Value\u2010Based Care Research Primary Care Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Center for Value\u2010Based Care Research Primary Care Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd9.110287"},{"key":"e_1_2_10_3_1","unstructured":"Centers for Disease Control and Prevention U.S. Dept of Health and Human Services National Diabetes Statistics Report 2021accessed on December 15 2025 https:\/\/www.cdc.gov\/diabetes\/php\/data\u2010research\/index.html."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20\u2010S012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13\u2010S011"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21\u2010S012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12\u20102258"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7345"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21\u20101507"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010200002000\u201000003"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010021\u201006710\u2010y"},{"issue":"6","key":"e_1_2_10_12_1","first-page":"e399","article-title":"Provider Behavior and Treatment Intensification in Diabetes Care","volume":"21","author":"Resnick H. 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