Adjusted percentages of patients receiving prescriptions for each second-line diabetes drug class
| DPP4 | GLP1 | INS/B | SGLT2 | SFU | TZD | |||||||
| % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | |
| Overall | 26.6 | 26.5 to 26.7 | 7.8 | 7.7 to 7.9 | 8.2 | 8.1 to 8.2 | 5.1 | 5.1 to 5.2 | 47.4 | 47.3 to 47.5 | 4.8 | 4.8 to 4.9 |
| Individual characteristics | ||||||||||||
| Gender | ||||||||||||
| Women | 26.7 | 26.1 to 27.3 | 10.1 | 9.7 to 10.5 | 8.4 | 8.0 to 8.8 | 5.2 | 4.9 to 5.5 | 45.3 | 44.6 to 46.0 | 4.3 | 4.0 to 4.6 |
| Men | 26.7 | 26.1 to 27.3 | 5.9 | 5.6 to 6.3 | 8.0 | 7.6 to 8.4 | 5.1 | 4.8 to 5.4 | 49.0 | 48.4 to 49.7 | 5.3 | 5.0 to 5.6 |
| Age | ||||||||||||
| 18–34 | 23.9 | 21.4 to 26.4 | 11.8 | 10.3 to 13.3 | 12.4 | 10.7 to 14.1 | 4.9 | 3.7 to 6.0 | 43.0 | 40.3 to 45.8 | 4.0 | 2.8 to 5.2 |
| 35–44 | 25.9 | 23.8 to 27.9 | 10.6 | 9.3 to 12.0 | 9.8 | 8.3 to 11.4 | 5.3 | 4.5 to 6.2 | 43.9 | 41.5 to 46.2 | 4.5 | 3.5 to 5.5 |
| 45–54 | 26.7 | 24.7 to 28.6 | 9.1 | 7.7 to 10.4 | 8.6 | 7.1 to 10.1 | 5.4 | 4.7 to 6.2 | 45.6 | 43.5 to 47.8 | 4.6 | 3.7 to 5.6 |
| 55–64 | 26.6 | 24.7 to 28.6 | 7.3 | 6.0 to 8.6 | 8.4 | 6.9 to 9.9 | 5.2 | 4.4 to 5.9 | 47.5 | 45.3 to 49.7 | 5.0 | 4.0 to 6.0 |
| 65–74 | 27.8 | 25.8 to 29.9 | 5.6 | 4.2 to 6.9 | 7.0 | 5.5 to 8.6 | 4.5 | 3.6 to 5.4 | 50.1 | 47.8 to 52.4 | 5.0 | 4.0 to 6.0 |
| 75+ | 28.0 | 25.5 to 30.5 | 3.4 | 1.9 to 4.9 | 6.6 | 4.9 to 8.3 | 2.3 | 1.2 to 3.5 | 54.5 | 51.8 to 57.3 | 5.2 | 4.0 to 6.3 |
| Recent healthcare cost level | ||||||||||||
| Low (below median) | 24.6 | 23.3 to 26.0 | 6.6 | 5.8 to 7.4 | 8.4 | 7.5 to 9.2 | 4.8 | 4.1 to 5.5 | 50.5 | 49.0 to 52.0 | 5.1 | 4.5 to 5.8 |
| High (>95thpercentile) | 29.6 | 28.3 to 31.0 | 10.2 | 9.4 to 11.1 | 8.3 | 7.4 to 9.1 | 6.0 | 5.3 to 6.7 | 41.5 | 40.1 to 43.0 | 4.3 | 3.6 to 4.9 |
| Recent hospitalization | 23.7 | 22.8 to 24.5 | 7.1 | 6.6 to 7.6 | 12.6 | 12.0 to 13.2 | 3.6 | 3.2 to 4.1 | 48.7 | 47.7 to 49.6 | 4.4 | 4.0 to 4.7 |
| Charlson Comorbidity Score* | ||||||||||||
| 0 (lowest) | 20.4 | 18.8 to 22.0 | 12.1 | 10.9 to 13.3 | 12.3 | 11.0 to 13.5 | 3.4 | 2.7 to 4.2 | 46.3 | 44.4 to 48.1 | 5.5 | 4.7 to 6.3 |
| 1 | 27.4 | 24.4 to 30.4 | 7.8 | 5.5 to 10.1 | 7.5 | 5.2 to 9.9 | 5.3 | 3.8 to 6.8 | 47.2 | 43.7 to 50.6 | 4.8 | 3.3 to 6.2 |
| 2 or 3 | 25.9 | 22.8 to 29.0 | 7.8 | 5.4 to 10.1 | 8.5 | 6.0 to 10.9 | 5.2 | 3.6 to 6.7 | 47.9 | 44.4 to 51.5 | 4.8 | 3.3 to 6.3 |
| 4+ (highest) | 27.0 | 23.7 to 30.2 | 6.6 | 4.2 to 9.0 | 8.7 | 6.2 to 11.2 | 4.8 | 3.2 to 6.4 | 48.0 | 44.3 to 51.7 | 4.9 | 3.3 to 6.5 |
| Diagnosis of obesity† | 25.7 | 25.0 to 26.5 | 10.8 | 10.3 to 11.3 | 6.9 | 6.4 to 7.3 | 5.9 | 5.5 to 6.2 | 46.5 | 45.6 to 47.3 | 4.3 | 3.9 to 4.7 |
| Most recent A1c value | ||||||||||||
| <8% | 31.3 | 29.3 to 33.3 | 10.4 | 9.2 to 11.6 | 4.5 | 3.1 to 5.8 | 6.1 | 5.3 to 7.0 | 41.9 | 39.7 to 44.2 | 5.7 | 4.6 to 6.7 |
| 8%–10% | 31.2 | 29.2 to 33.2 | 6.4 | 5.3 to 7.5 | 4.6 | 3.2 to 5.9 | 5.3 | 4.5 to 6.1 | 47.8 | 45.6 to 50.0 | 4.7 | 3.7 to 5.7 |
| >10% | 23.8 | 21.7 to 25.8 | 5.6 | 4.4 to 6.7 | 13.0 | 11.3 to 14.7 | 4.6 | 3.7 to 5.4 | 48.9 | 46.5 to 51.3 | 4.2 | 3.1 to 5.2 |
| Result not available‡ | 25.2 | 24.2 to 26.2 | 7.9 | 7.3 to 8.5 | 8.9 | 8.0 to 9.7 | 4.9 | 4.5 to 5.4 | 48.3 | 47.1 to 49.5 | 4.8 | 4.3 to 5.3 |
| Diagnosis of poor control§ | 27.5 | 26.8 to 28.1 | 7.6 | 7.2 to 8.0 | 9.7 | 9.3 to 10.1 | 5.1 | 4.8 to 5.4 | 45.7 | 45.0 to 46.4 | 4.5 | 4.2 to 4.8 |
| Prescriber characteristics | ||||||||||||
| Clinical discipline | ||||||||||||
| Endocrinology | 28.1 | 26.4 to 29.8 | 10.6 | 9.6 to 11.5 | 10.1 | 8.9 to 11.3 | 4.6 | 3.9 to 5.3 | 43.2 | 41.2 to 45.2 | 3.5 | 2.7 to 4.3 |
| Family practice | 26.6 | 25.1 to 28.2 | 7.2 | 6.4 to 8.1 | 7.8 | 6.8 to 8.9 | 5.5 | 4.9 to 6.1 | 47.2 | 45.4 to 49.0 | 5.5 | 4.9 to 6.2 |
| General/Internal | 27.1 | 25.5 to 28.6 | 7.4 | 6.6 to 8.3 | 7.8 | 6.8 to 8.8 | 5.1 | 4.5 to 5.7 | 48.5 | 46.7 to 50.2 | 4.2 | 3.6 to 4.9 |
| Proportion of patients for which type 2 diabetes drugs were prescribed¶ | ||||||||||||
| Lowest quartile | 27.7 | 26.8 to 28.7 | 5.7 | 5.1 to 6.3 | 8.2 | 7.6 to 8.8 | 4.6 | 4.2 to 5.1 | 49.1 | 48.0 to 50.1 | 4.7 | 4.2 to 5.1 |
| Highest quartile | 25.1 | 24.2 to 26.1 | 9.9 | 9.3 to 10.5 | 8.9 | 8.3 to 9.6 | 5.3 | 4.9 to 5.8 | 45.3 | 44.2 to 46.4 | 5.4 | 4.9 to 5.9 |
| Recent prescribing behavior | ||||||||||||
| Top quartile of DPP4 use | 41.1 | 39.4 to 42.8 | 7.4 | 6.4 to 8.5 | 6.6 | 5.5 to 7.6 | 5.2 | 4.5 to 6.0 | 35.5 | 33.7 to 37.3 | 4.2 | 3.4 to 4.9 |
| Any GLP1 use | 28.1 | 26.5 to 29.6 | 14.7 | 13.5 to 15.9 | 8.5 | 7.5 to 9.6 | 5.4 | 4.7 to 6.1 | 38.8 | 37.1 to 40.6 | 4.5 | 3.8 to 5.3 |
| Top quartile of INS/B use | 25.5 | 23.7 to 27.2 | 7.5 | 6.5 to 8.6 | 10.3 | 9.2 to 11.4 | 5.0 | 4.2 to 5.8 | 47.6 | 45.7 to 49.5 | 4.0 | 3.2 to 4.9 |
| Any SGLT2 use | 28.2 | 26.9 to 29.4 | 7.8 | 7.1 to 8.4 | 8.6 | 7.8 to 9.5 | 11.8 | 11.2 to 12.4 | 38.5 | 37.1 to 39.8 | 5.1 | 4.4 to 5.8 |
| Top quartile of SFU use | 20.2 | 18.3 to 22.0 | 4.9 | 3.7 to 6.1 | 7.0 | 5.8 to 8.2 | 3.7 | 2.8 to 4.6 | 60.9 | 58.9 to 62.8 | 3.3 | 2.3 to 4.3 |
| Top quartile of TZD use | 26.9 | 25.3 to 28.5 | 7.8 | 6.8 to 8.8 | 7.6 | 6.6 to 8.6 | 5.4 | 4.5 to 6.2 | 42.2 | 40.4 to 43.9 | 10.1 | 9.1 to 11.2 |
| Census region where healthcare was received | ||||||||||||
| Northeast | 31.6 | 30.4 to 32.9 | 8.0 | 7.3 to 8.8 | 7.4 | 6.6 to 8.1 | 5.0 | 4.4 to 5.6 | 44.0 | 42.6 to 45.3 | 4.0 | 3.4 to 4.6 |
| Midwest | 23.6 | 22.4 to 24.9 | 7.4 | 6.7 to 8.1 | 8.5 | 7.8 to 9.2 | 4.8 | 4.2 to 5.4 | 51.1 | 49.8 to 52.4 | 4.5 | 3.9 to 5.1 |
| South | 26.8 | 25.7 to 28.0 | 8.1 | 7.4 to 8.7 | 7.9 | 7.2 to 8.6 | 5.6 | 5.0 to 6.1 | 47.4 | 46.2 to 48.6 | 4.3 | 3.7 to 4.8 |
| West | 26.4 | 25.2 to 27.7 | 7.7 | 6.9 to 8.4 | 8.8 | 8.0 to 9.5 | 4.5 | 3.9 to 5.1 | 46.3 | 45.0 to 47.7 | 6.3 | 5.7 to 6.9 |
| Insurance and health plan characteristics | ||||||||||||
| Insurance category | ||||||||||||
| Commercial | 27.4 | 26.0 to 28.8 | 8.0 | 7.1 to 8.9 | 7.8 | 6.7 to 8.9 | 5.2 | 4.5 to 6.0 | 46.8 | 45.2 to 48.4 | 4.8 | 4.1 to 5.5 |
| Medicare | 22.8 | 21.4 to 24.2 | 6.2 | 5.3 to 7.1 | 10.9 | 9.8 to 12.0 | 2.9 | 2.2 to 3.6 | 52.0 | 50.3 to 53.6 | 5.3 | 4.5 to 6.0 |
| Health plan structure | ||||||||||||
| Indemnity plan | 24.0 | 20.7 to 27.2 | 6.8 | 4.4 to 9.3 | 9.8 | 7.6 to 12.1 | 6.3 | 4.0 to 8.5 | 48.1 | 44.5 to 51.8 | 5.0 | 3.4 to 6.5 |
| Preferred provider organization | 25.3 | 23.0 to 27.5 | 8.1 | 6.8 to 9.5 | 8.1 | 6.6 to 9.6 | 5.4 | 4.2 to 6.5 | 47.4 | 44.8 to 49.9 | 5.7 | 4.5 to 7.0 |
| Exclusive provider organization | 25.2 | 22.9 to 27.4 | 7.4 | 6.1 to 8.8 | 8.3 | 6.8 to 9.8 | 4.8 | 3.7 to 6.0 | 49.0 | 46.5 to 51.6 | 5.2 | 3.9 to 6.5 |
| Point of service plan | 26.9 | 25.8 to 28.0 | 8.1 | 7.5 to 8.7 | 8.1 | 7.4 to 8.9 | 5.3 | 4.9 to 5.8 | 46.8 | 45.6 to 48.0 | 4.8 | 4.2 to 5.4 |
| Health maintenance organization | 26.8 | 25.5 to 28.1 | 7.2 | 6.5 to 7.9 | 8.2 | 7.3 to 9.1 | 4.5 | 3.9 to 5.0 | 48.5 | 47.1 to 50.0 | 4.8 | 4.1 to 5.5 |
| Richness of health plan benefits based on out-of-pocket costs as percent of total costs for all enrollees in the same plan** | ||||||||||||
| Lowest quartile cost share | 24.3 | 23.2 to 25.5 | 7.4 | 6.7 to 8.1 | 9.1 | 8.4 to 9.8 | 5.1 | 4.5 to 5.7 | 49.2 | 48.0 to 50.5 | 4.9 | 4.3 to 5.4 |
| Highest quartile cost share | 26.9 | 26.0 to 27.8 | 7.7 | 7.1 to 8.3 | 7.9 | 7.3 to 8.5 | 5.5 | 5.0 to 5.9 | 46.9 | 45.8 to 47.9 | 5.2 | 4.7 to 5.6 |
All estimates are adjusted for all other covariates in the table; some covariate categories are not included here for space constraints; please see online supplementary appendix for complete classification and adjusted estimates for each variable.
*Generally reflects a count of comorbid conditions (higher numbers reflect greater comorbidity).
†Reflects a prior encounter with an obesity diagnosis code (see online supplementary appendix for details).
‡Lab values are not routinely available in health plan administrative data sources unless submitted by the laboratory vendor as part of their contract with the health payer; for these data, 38% of submitted laboratory claims nationally included a result.
§Reflects a prior encounter for uncontrolled or poorly controlled diabetes (see online supplementary appendix for details).
¶For percentage of prescriptions that were for diabetes: lowest quartile=≤7.7% of patients; highest quartile=≥20.0% of patients. For percent of patient total costs that were out-of-pocket costs: lowest quartile=≤6.1% of total costs; highest quartile=≥11.7% of total costs.
**The highest quartile of health plan “richness” corresponds to the plans with the lowest median out of pocket costs, calculated as the percentage of total healthcare costs paid by the patient, rather than by the plan, for all patients in the same plan.
DPP4, dipeptidyl peptidase-4 inhibitors; GLP1, glucagon-like peptide-1 receptor agonists; INS/B, long-acting or intermediate-acting insulin given as a basal (rather than mealtime) injection; SGLT2, sodium-glucose cotransporter 2 inhibitors; SFU, sulfonylurea or meglitinides; TZD, thiazolidinediones.