Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006-2013

Kasia J. Lipska, Xiaoxi Yao, Jeph Herrin, Rozalina McCoy, Joseph S. Ross, Michael A. Steinman, Silvio E. Inzucchi, Thomas M. Gill, Harlan M. Krumholz, Nilay D Shah

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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 sexstandardized 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), declinedmodestly 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.

Original languageEnglish (US)
Pages (from-to)468-475
Number of pages8
JournalDiabetes Care
Volume40
Issue number4
DOIs
StatePublished - Apr 1 2017

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Drug Utilization
Hypoglycemia
Hemoglobins
Comorbidity
Medicare Part C
Dipeptidyl-Peptidase IV Inhibitors
Glucose
Thiazolidinediones
Metformin
Type 2 Diabetes Mellitus
Research Design
Age Groups
Insulin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006-2013. / Lipska, Kasia J.; Yao, Xiaoxi; Herrin, Jeph; McCoy, Rozalina; Ross, Joseph S.; Steinman, Michael A.; Inzucchi, Silvio E.; Gill, Thomas M.; Krumholz, Harlan M.; Shah, Nilay D.

In: Diabetes Care, Vol. 40, No. 4, 01.04.2017, p. 468-475.

Research output: Contribution to journalArticle

Lipska, KJ, Yao, X, Herrin, J, McCoy, R, Ross, JS, Steinman, MA, Inzucchi, SE, Gill, TM, Krumholz, HM & Shah, ND 2017, 'Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006-2013', Diabetes Care, vol. 40, no. 4, pp. 468-475. https://doi.org/10.2337/dc16-0985
Lipska, Kasia J. ; Yao, Xiaoxi ; Herrin, Jeph ; McCoy, Rozalina ; Ross, Joseph S. ; Steinman, Michael A. ; Inzucchi, Silvio E. ; Gill, Thomas M. ; Krumholz, Harlan M. ; Shah, Nilay D. / Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006-2013. In: Diabetes Care. 2017 ; Vol. 40, No. 4. pp. 468-475.
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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 sexstandardized 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), declinedmodestly 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.",
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T1 - Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006-2013

AU - Lipska, Kasia J.

AU - Yao, Xiaoxi

AU - Herrin, Jeph

AU - McCoy, Rozalina

AU - Ross, Joseph S.

AU - Steinman, Michael A.

AU - Inzucchi, Silvio E.

AU - Gill, Thomas M.

AU - Krumholz, Harlan M.

AU - Shah, Nilay D

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N2 - 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 sexstandardized 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), declinedmodestly 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.

AB - 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 sexstandardized 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), declinedmodestly 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.

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