Format

Send to

Choose Destination
Diabetes Care. 2017 Nov;40(11):1500-1505. doi: 10.2337/dc17-0213. Epub 2017 Sep 13.

Antihyperglycemic Medications: A Claims-Based Estimate of First-line Therapy Use Prior to Initialization of Second-line Medications.

Author information

1
Computational Health Informatics Program, Boston Children's Hospital, Boston, MA.
2
Department of Information Management, Chang Gung University, Taoyuan City, Taiwan.
3
Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan.
4
Independent author, Dingmans Ferry, PA.
5
Aetna, Inc., Hartford, CT.
6
Computational Health Informatics Program, Boston Children's Hospital, Boston, MA kenneth_mandl@harvard.edu.
7
Department of Pediatrics, Harvard Medical School, Boston, MA.
8
Department of Biomedical Informatics, Harvard Medical School, Boston, MA.

Abstract

OBJECTIVE:

The American Diabetes Association recommends metformin as first-line therapy for type 2 diabetes. However, nonadherence to antihyperglycemic medication is common, and a clinician could confuse nonadherence with pharmacologic failure, potentially leading to premature prescribing of second-line therapies. We measured metformin use prior to second-line therapy initialization.

RESEARCH DESIGN AND METHODS:

This retrospective cross-sectional study used unidentifiable member claims data from individuals covered from 2010 to 2015 by Aetna, a U.S. health benefits company. Beneficiaries with two physician claims or one hospitalization with a type 2 diabetes diagnosis were included. Recommended use of metformin was measured by the proportion of days covered over 60 days. Through sensitivity analysis, we varied estimates of the percentage of beneficiaries who used low-cost generic prescription medication programs.

RESULTS:

A total of 52,544 individuals with type 2 diabetes were eligible. Of 22,956 patients given second-line treatment, only 1,875 (8.2%) had evidence of recommended use of metformin in the prior 60 days, and 6,441 (28.0%) had no prior claims evidence of having taken metformin. At the top range of sensitivity, only 49.5% patients could have had recommended use. Patients were more likely to be given an additional second-line antihyperglycemic medication or insulin if they were given their initial second-line medication without evidence of recommended use of metformin (P < 0.001).

CONCLUSIONS:

Despite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common. Point-of-care and population-level processes are needed to monitor and improve guideline adherence.

PMID:
28903978
PMCID:
PMC5652584
[Available on 2018-11-01]
DOI:
10.2337/dc17-0213
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center