Adoption of New Glucose-Lowering Medications in the U.S.—The Case of SGLT2 Inhibitors: Nationwide Cohort Study

McCoy, Rozalina G.; Dykhoff, Hayley J.; Sangaralingham, Lindsey R.; Ross, Joseph S.; Karaca‐Mandic, Pinar; Montori, Víctor M.; Shah, Nilay D.

doi:10.1089/dia.2019.0213

Cited by 97 publications

(86 citation statements)

References 50 publications

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“…Finally, the proportions of older and clinically complex patients treated with insulin/sulfonylurea to achieve low HbA 1c targets were comparable to earlier studies,7–9 12 despite the increasing availability of medications posing a lower risk of hypoglycemia (DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors) and with additional cardiovascular and renal benefits (GLP-1 receptor agonists, SGLT2 inhibitors)18 than insulin and sulfonylurea. This is consistent with recent findings that older patients and patients with CKD, heart failure, and cardiovascular disease are all less likely to be prescribed SGLT2 inhibitors than younger and healthier people, despite their benefit in these contexts 39. Our study therefore reinforces the age and comorbidity-driven risk/treatment paradox in glucose-lowering therapy.…”

Section: Discussionsupporting

confidence: 92%

Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes

McCoy

Lipska

Houten

et al. 2020

BMJ Open Diab Res Care

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IntroductionGlycemic targets and glucose-lowering regimens should be individualized based on multiple factors, including the presence of comorbidities. We examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity.Research design and methodsWe retrospectively examined glycosylated hemoglobin (HbA1c) levels and rates of insulin/sulfonylurea use as a function of age and multimorbidity using administrative claims and laboratory data for adults with type 2 diabetes included in OptumLabs Data Warehouse, 1 January 2014 to 31 December 2016. Comorbidity burden was assessed by counts of any of 16 comorbidities specified by guidelines as warranting relaxation of HbA1c targets, classified as being diabetes concordant (diabetes complications or risk factors), discordant (unrelated to diabetes), or advanced (life limiting).ResultsAmong 194 157 patients with type 2 diabetes included in the study, 45.2% had only concordant comorbidities, 30.6% concordant and discordant, 2.7% only discordant, and 13.0% had ≥1 advanced comorbidity. Mean HbA1c was 7.7% among 18–44 year-olds versus 6.9% among ≥75 year-olds, and was higher among patients with comorbidities: 7.3% with concordant only, 7.1% with discordant only, 7.1% with concordant and discordant, and 7.0% with advanced comorbidities compared with 7.4% among patients without comorbidities. The odds of insulin use decreased with age (OR 0.51 (95% CI 0.48 to 0.54) for age ≥75 vs 18–44 years) but increased with accumulation of concordant (OR 5.50 (95% CI 5.22 to 5.79) for ≥3 vs none), discordant (OR 1.72 (95% CI 1.60 to 1.86) for ≥3 vs none), and advanced (OR 1.45 (95% CI 1.25 to 1.68) for ≥2 vs none) comorbidities. Conversely, sulfonylurea use increased with age (OR 1.36 (95% CI 1.29 to 1.44) for age ≥75 vs 18–44 years) but decreased with accumulation of concordant (OR 0.76 (95% CI 0.73 to 0.79) for ≥3 vs none), discordant (OR 0.70 (95% CI 0.64 to 0.76) for ≥3 vs none), but not advanced (OR 0.86 (95% CI 0.74 to 1.01) for ≥2 vs none) comorbidities.ConclusionsThe proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite potential for hypoglycemia and uncertain long-term benefit.

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Section: Discussionsupporting

confidence: 92%

Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes

McCoy

Lipska

Houten

et al. 2020

BMJ Open Diab Res Care

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“…Diabetes guidelines, such as the 2020 ADA Standards of Care [ 27 ] and the 2019 Consensus Statement from the American Association of Clinical Endocrinologists [ 28 ], explicitly recommend SGLT2 inhibitors and GLP-1 RAs with CV benefits for patients with these conditions. Nevertheless, a recent nationwide cohort study that retrospectively analyzed medical and pharmacy claims from 1,054,727 adults with pharmacologically treated diabetes revealed that patients with prior myocardial infarction or heart failure were less likely to receive SGLT2 inhibitors (OR 0.94 and 0.93, respectively, P < 0.001 for both), despite evidence supporting their preferential use in these patients [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Care Physicians’ Knowledge of the Cardiovascular Effects of Diabetes Medications: Findings from an Online Survey

2020

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Introduction: Cardiovascular (CV) outcomes trial (CVOT) results have led to changes in indications for some glucose-lowering agents, with recommendations based on the presence of comorbidities. Objective: This study aimed to understand internal medicine (IM) and family medicine (FM) physicians' knowledge of CVOTs and beliefs about type 2 diabetes mellitus (T2DM) medications, excluding insulin, for CV disease risk reduction. Methods: WebMD, LLC, fielded a 23-item online survey from September 18 to 20, 2018, to 47,534 Medscape members (US IM and FM physicians) who were invited to participate via e-mail (quota = 500).

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“…In a study by McCoy et al, they had found that younger, healthier, non‐Black patients were more likely to start on a SGLT2 inhibitor. [ 32 ] This is a disturbing trend that can eventually impact not only health outcomes of socially disadvantaged groups, but also lead to higher healthcare costs and inappropriate use of health services like emergency departments. Exploring interventions that reduce disparities may help in reducing the differences observed in health expenditures and health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Health expenditure and health services utilization comparison of patients with type 2 diabetes on sodium–glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: evidence from 2015 to 2016 medical expenditure panel survey

Patel

Vaidya

2020

Journal of Pharmaceutical Health Services Research

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Objectives Primary objective of this study was to compare the overall health expenditures of patients with type 2 diabetes on sodium–glucose cotransporter‐2 (SGLT2) inhibitors versus dipeptidyl peptidase‐4 (DPP4) inhibitors. Methods Two cohorts of type 2 diabetes patients receiving either SGLT2 inhibitor with metformin or DPP4 inhibitor with metformin were identified from 2015 to 2016 Medical Expenditure Panel Survey (MEPS) data. Propensity score matching was used to balance cohorts based on socio‐economic status, insulin utilization status, and the Charlson comorbidity score. Patients in SGLT2 inhibitor cohort were matched with patients in DPP4 inhibitor cohort using 1 : 2 ratio on the logit of propensity score using caliper width of 0.1 of the standard deviation of the logit of the propensity score. Expenditure variables were analysed using a generalized linear model with log link function and gamma distribution and adjusted for socio‐economic variables. Unadjusted means were obtained using bootstrap. Results After propensity score matching, 240 patients were left in the sample with 80 patients in SGLT2 inhibitor cohort and 160 patients in DPP4 inhibitor cohort. Unadjusted average annual total health expenditure was significantly higher in the SGLT2 inhibitor cohort versus DPP4 inhibitor cohort ($17,325 versus $15,702; P value <0.0001). After adjusting for socio‐economic factors, overall health expenditure (β = −0.3516; P = 0.0038) was significantly lower in DPP4 inhibitor cohort compared to SGLT2 inhibitor. Conclusion SGLT2 inhibitors were associated with significantly higher overall and prescription expenditures compared to DPP4 inhibitors during the study period evaluated. Future studies need to utilize administrative claims data to assess current comparativeness effectiveness trends.

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Adoption of New Glucose-Lowering Medications in the U.S.—The Case of SGLT2 Inhibitors: Nationwide Cohort Study

Cited by 97 publications

References 50 publications

Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes

Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes

Primary Care Physicians’ Knowledge of the Cardiovascular Effects of Diabetes Medications: Findings from an Online Survey

Health expenditure and health services utilization comparison of patients with type 2 diabetes on sodium–glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: evidence from 2015 to 2016 medical expenditure panel survey

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