Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013 - PubMed (original) (raw)

. 2017 Apr;40(4):468-475.

doi: 10.2337/dc16-0985. Epub 2016 Sep 22.

Affiliations

Kasia J Lipska et al. Diabetes Care. 2017 Apr.

Abstract

Objective: To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).

Research design and methods: Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).

Results: From 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).

Conclusions: During the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged.

© 2017 by the American Diabetes Association.

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Figures

Figure 1

Figure 1

Age- and sex-standardized proportion of patients with T2DM who filled each class of glucose-lowering agents, 2006 and 2013 (see

Supplementary Table 2

for annual data). Since patients may fill more than one class in each year, percentages do not add up to 100%. Other medications were comprised of meglitinides, α-glucosidase inhibitors, SGLT-2 inhibitors, and amylin analogs. Patients with no fills for glucose-lowering medications were included in the “No medications” group.

Figure 2

Figure 2

Glycemic control among patients with T2DM, 2006–2013. Estimates were standardized by age, sex, race, and region to the 2013 cohort of people included in the study.

Figure 3

Figure 3

Age- and sex-standardized rate of severe hypoglycemia resulting in hospital admission, observation stay, or emergency department visit per 100 person-years, 2006–2013. A: Patients with T2DM who filled at least one glucose-lowering agent. B: Patients with T2DM who filled insulin or insulin secretagogues (diamonds), other glucose-lowering agents (triangles), and no glucose-lowering agents (circles). SU, sulfonylurea.

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