Article Text
Abstract
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.
- diabetes mellitus
- type 2
- medication utilization
- pharmacoepidemiology
- case comparison study design
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Contributors RTA contributed to the study design, interpreted analytic results and drafted the manuscript; AC and RK contributed to the study design, managed and cleaned raw data received from the sponsor, conducted the analyses, interpreted the findings, and edited/revised the manuscript; AW, MJO, DTL and MRM contributed to the study design, interpreted the results and edited/revised the manuscript.
Funding This work was supported by United Healthcare Services.
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.