Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006 2013
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 sex standardized 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) declined modestly 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.
Diabetes Care