County-level variation in cardioprotective antihyperglycemic prescribing among medicare beneficiaries

Hanna, Jonathan; Nargesi, Arash Aghajani; Essien, Utibe R.; Sangha, Veer; Lin, Zhenqiu; Krumholz, Harlan M.; Khera, Rohan

doi:10.1016/j.ajpc.2022.100370

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…Furthermore, when we compared basal insulin-GLP-1RA dual users, we did not observe greater proportions of PwT2D with a history of CVD, MI, CHF, or CKD initiating GLP-1RA before basal insulin. These findings are consistent with prior evidence that have suggested suboptimal utilization of GLP-1RAs and SGLT-2is by PwT2D with underlying ASCVD or CKD [ 27 , 30 , 31 ]. This is despite new clinical and society guidelines supporting use of GLP-1RA before basal insulin in PwT2D with these comorbidities [ 2 ].…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, there may be other patient-related factors associated with GLP-1RA/SGLT-2i prescription that were not accounted for in our study. For example, Hanna et al [ 30 ], reported GLP-1RA/SGLT-2i prescription was higher in US counties with a population of low median age, non-rural areas, northeastern USA, and in areas with a lower proportion of Hispanic individuals (GLP-1RA only). Thus, there is a need to further investigate patient-related factors associated with the increasing utilization of GLP-1RAs and SGLT-2is among basal insulin users in the real world.…”

Section: Discussionmentioning

confidence: 99%

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Real-World Patterns of Basal Insulin Use with Other Diabetes Medications Among People with Type 2 Diabetes Between 2014 and 2020

SCHAPIRO

Juneja

Huang³

et al. 2023

Diabetes Ther

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Introduction Basal insulin’s position in the type 2 diabetes (T2D) treatment paradigm has undergone significant revisions since the advent of diabetes medications such as glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is), which offer cardiorenal protection for people with T2D (PwT2D). This study aimed to characterize the demographic, clinical, and diabetes medication utilization patterns of PwT2D initiating basal insulin between 2014 and 2020 over the time period when these revisions were occurring. Methods A retrospective study was conducted using the IBM ® MarketScan ® databases and included adults with T2D who initiated basal insulin therapy (basal insulin initiators) in 2015, 2017, or 2019. Patient characteristics, medication utilization patterns, and time to add an additional diabetes drug class were compared across years. Characteristics of users of basal insulin-GLP-1RA combination therapy (GLP-1RA-basal insulin dual users) were also compared across years. Results Between 2015 and 2019, initiation of basal insulin therapy remained steady, with 1.6–1.9% of PwT2D starting basal insulin in each year. GLP-1RA and SGLT-2i use increased pre- and post-basal insulin initiation (pre-basal: GLP-1RA, from 14.8% to 25.2%, p < 0.0001; SGLT-2i, from 11.4% to 20.5%, p < 0.0001; post-basal: GLP-1RA, from 16.7% to 30.5%, p < 0.0001; SGLT-2i, from 13.4% to 23.3%, p < 0.0001]). The proportion of PwT2D with underlying cardiovascular and renal diseases did not increase during this period. Among basal insulin initiators without prior GLP-1RA, SGLT-2i, or bolus insulin use, time to adding on these agents decreased, with 14.0–15.6% starting bolus insulin within the first year. Among GLP-1RA-basal insulin dual initiators, the proportion of those with underlying cardiovascular disease was not higher among GLP-1RA first users. Conclusions In this real-world study, insulin remained key in the T2D treatment paradigm. A growing proportion of PwT2D utilized GLP-1RAs and SGLT-2is before and after initiation of basal insulin therapy. At the same time, there was no increase in the proportion of those initiating basal insulin who had cardiorenal comorbidity profiles for which treatment guidelines have recommended the use of GLP-1RAs or SGLT-2is. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01414-4.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Real-World Patterns of Basal Insulin Use with Other Diabetes Medications Among People with Type 2 Diabetes Between 2014 and 2020

SCHAPIRO

Juneja

Huang³

et al. 2023

Diabetes Ther

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“…Unfortunately, most AI and ML-based tools fail to translate into improved outcomes for our patients and communities. This gap between evidence generation and clinical implementation is exemplified by the subpar real-world uptake of multiple therapies that reduce cardiovascular risk [ 14 – 17 ]. Furthermore, the current paradigm of medical AI heavily relies on existing data streams that reflect and thus perpetuate systemic biases.…”

Section: Introductionmentioning

confidence: 99%

Machine learning in precision diabetes care and cardiovascular risk prediction

Oikonomou,

Khera

2023

Cardiovasc Diabetol

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Artificial intelligence and machine learning are driving a paradigm shift in medicine, promising data-driven, personalized solutions for managing diabetes and the excess cardiovascular risk it poses. In this comprehensive review of machine learning applications in the care of patients with diabetes at increased cardiovascular risk, we offer a broad overview of various data-driven methods and how they may be leveraged in developing predictive models for personalized care. We review existing as well as expected artificial intelligence solutions in the context of diagnosis, prognostication, phenotyping, and treatment of diabetes and its cardiovascular complications. In addition to discussing the key properties of such models that enable their successful application in complex risk prediction, we define challenges that arise from their misuse and the role of methodological standards in overcoming these limitations. We also identify key issues in equity and bias mitigation in healthcare and discuss how the current regulatory framework should ensure the efficacy and safety of medical artificial intelligence products in transforming cardiovascular care and outcomes in diabetes.

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Bridging the gap in cardiovascular care in diabetic patients: are cardioprotective antihyperglycemic agents underutilized?

Scheen

2023

Expert Review of Clinical Pharmacology

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County-level variation in cardioprotective antihyperglycemic prescribing among medicare beneficiaries

Cited by 6 publications

References 36 publications

Real-World Patterns of Basal Insulin Use with Other Diabetes Medications Among People with Type 2 Diabetes Between 2014 and 2020

Real-World Patterns of Basal Insulin Use with Other Diabetes Medications Among People with Type 2 Diabetes Between 2014 and 2020

Machine learning in precision diabetes care and cardiovascular risk prediction

Bridging the gap in cardiovascular care in diabetic patients: are cardioprotective antihyperglycemic agents underutilized?

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