Abstract
OBJECTIVES: To describe changes in antidiabetic medication (ADM) use and characteristics associated with changes in ADM use after initiation of noninsulin second-line therapy. STUDY DESIGN: Retrospective cohort study. METHODS: This study analyzed private health plan claims for adults with type 2 diabetes who initiated 1 of 5 index ADM classes: sulfonylureas, dipeptidyl peptidase 4 inhibitors (DPP4is), sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or thiazolidinediones. Analyses evaluated 3 treatment modification outcomes—discontinuation, switching, and intensification—over 12-month follow-up. RESULTS: Of 82,624 included adults, nearly two-thirds (63.6%) experienced any treatment modification. Discontinuation was the most common modification (38.6%), especially among patients prescribed GLP-1 RAs (50.3%). Switching occurred in 5.2% of patients and intensification in 19.8%. In adjusted analysis, compared with patients prescribed sulfonylureas, discontinuation risk was 7% higher (HR, 1.07; 95% CI, 1.04-1.10) among patients prescribed DPP4is and 28% higher (HR, 1.28; 95% CI, 1.23-1.33) among patients prescribed GLP-1 RAs. Compared with sulfonylureas, all other index ADM classes had higher risks of switching and lower risks of intensification. Younger age group and female sex were both associated with higher risks of all modifications. Compared with index ADM prescription by a family medicine or internal medicine physician, index prescription by an endocrinologist was associated with both lower discontinuation risk and higher intensification risk. CONCLUSIONS: Most patients experienced a treatment modification within 1 year. Results highlight the need for new prescribing approaches and patient supports that can maximize medication adherence and reduce health system waste.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 661-668 |
| Number of pages | 8 |
| Journal | American Journal of Managed Care |
| Volume | 29 |
| Issue number | 12 |
| DOIs | |
| State | Published - 2023 |
Funding
Funding support and data access for this work were provided through a grant to Northwestern University from UnitedHealth Group, the company whose insurance arm provided coverage to the members under study. The authors thank Sanya Pasricha, UnitedHealth Group, for help with preparation of manuscript tables and figures. The authors thank Sterling Harris, Northwestern University, for project management support. Interim study findings were presented virtually at the American Diabetes Association Scientific Sessions on June 13, 2020. Funding support and data access for this work were provided through a grant to Northwestern University from UnitedHealth Group, the company whose insurance arm provided coverage to the members under study. Source of Funding: Funding support for this work was provided through a grant to Northwestern University from UnitedHealth Group.
ASJC Scopus subject areas
- Health Policy
