TY - JOUR
T1 - Correlates of second-line type 2 diabetes medication selection in the USA
AU - Ackermann, Ronald T.
AU - Wallia, Amisha
AU - O'brien, Matthew J.
AU - Kang, Raymond
AU - Cooper, Andrew
AU - Moran, Margaret R.
AU - Liss, David T.
N1 - Funding Information:
This work was supported by United Healthcare Services.
Funding Information:
Competing interests AW discloses that she has received research grant support from Eli Lilly and has done trial adjudication for Lexicon Therapeutics, both of which are unrelated to this work. Patient consent The Northwestern University Institutional Review Board determined that this work was not classifiable as human subjects research. Patient consent was not required. Provenance and peer review Not commissioned; externally peer reviewed.
Publisher Copyright:
© 2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Objective Past research provides insufficient evidence to inform second-line diabetes medication prescribing when metformin is no longer sufficient. We evaluated patient, prescriber, and health plan characteristics associated with selection of second-line diabetes medications in the USA. Research design and methods We used a multiple case-comparison study design to identify characteristics associated with the probability of starting each of six second-line diabetes medication alternatives within 77 744 adults enrolled in commercial or Medicare Advantage health plans from 2011 to 2015. National administrative data were provided by a large commercial health payer. Multinomial logistic regression models were used to identify characteristics independently associated with selecting each diabetes drug class. Results From 2011 to 2015, sulfonylureas still represented 47% of all second-line drug starts, with proportionately higher use in patients ≥75 years of age (63% of drug starts). Basal insulin was more likely to be selected when a past A1c test result was >10% (13.0% vs 4.5% for those with A1c <8%; p<0.001). Initiation of a glucagon-like peptide-1 receptor agonist was associated with being female (10.1% vs 6.0% for male; p<0.001) and having a diagnosis code for obesity (10.8% vs 6.9% for no diagnosis; p<0.001). For all drug classes, the recent prescribing behavior of the provider was a strong correlate of subsequent second-line drug selection. Conclusions Sulfonylureas continue to represent almost half of second-line diabetes medication starts in the USA. This could reflect overuse for some groups such as older adults, for whom some alternatives may be safer, although more costly and potentially less effective. Future research should compare outcomes of medication choices and conditions under which particular classes are most effective.
AB - Objective Past research provides insufficient evidence to inform second-line diabetes medication prescribing when metformin is no longer sufficient. We evaluated patient, prescriber, and health plan characteristics associated with selection of second-line diabetes medications in the USA. Research design and methods We used a multiple case-comparison study design to identify characteristics associated with the probability of starting each of six second-line diabetes medication alternatives within 77 744 adults enrolled in commercial or Medicare Advantage health plans from 2011 to 2015. National administrative data were provided by a large commercial health payer. Multinomial logistic regression models were used to identify characteristics independently associated with selecting each diabetes drug class. Results From 2011 to 2015, sulfonylureas still represented 47% of all second-line drug starts, with proportionately higher use in patients ≥75 years of age (63% of drug starts). Basal insulin was more likely to be selected when a past A1c test result was >10% (13.0% vs 4.5% for those with A1c <8%; p<0.001). Initiation of a glucagon-like peptide-1 receptor agonist was associated with being female (10.1% vs 6.0% for male; p<0.001) and having a diagnosis code for obesity (10.8% vs 6.9% for no diagnosis; p<0.001). For all drug classes, the recent prescribing behavior of the provider was a strong correlate of subsequent second-line drug selection. Conclusions Sulfonylureas continue to represent almost half of second-line diabetes medication starts in the USA. This could reflect overuse for some groups such as older adults, for whom some alternatives may be safer, although more costly and potentially less effective. Future research should compare outcomes of medication choices and conditions under which particular classes are most effective.
KW - case comparison study design
KW - diabetes mellitus
KW - medication utilization
KW - pharmacoepidemiology
KW - type 2
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U2 - 10.1136/bmjdrc-2017-000421
DO - 10.1136/bmjdrc-2017-000421
M3 - Article
C2 - 29225892
AN - SCOPUS:85047610018
VL - 5
JO - BMJ Open Diabetes Research and Care
JF - BMJ Open Diabetes Research and Care
SN - 2052-4897
IS - 1
M1 - e000421
ER -