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Diabetes Care. 2017 Apr;40(4):468-475. doi: 10.2337/dc16-0985. Epub 2016 Sep 22.

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

Author information

1
Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT kasia.lipska@yale.edu.
2
Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
3
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
4
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
5
Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
6
Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
7
Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.
8
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco VA Health Care System, San Francisco, CA.
9
Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
10
Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
11
OptumLabs, Cambridge, MA.

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.

PMID:
27659408
PMCID:
PMC5360291
DOI:
10.2337/dc16-0985
[Indexed for MEDLINE]
Free PMC Article

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