Guideline Adherence and Control Of Diabetes Mellitus With Co-Morbidities in a Tertiary-Care Hospital in Malaysia

Abstract

A353 p= 0.03), use of 3rd generation SU ; p= 0.002), and chronic renal disease ; p= 0.01). ConClusions: In conclusion, multiple factors, including efficacy and hypoglycemia, are associated with discontinuation of SU treatment after insulin initiation.objeCtives: Sulfonylurea (SU) may be discontinued or down-titrated due to hypoglycemia. Hypoglycemia may be more concerning for patients not receiving aggressive efficacy-driven treatment such as the dual-therapy of SU and insulin. A retrospective cohort study using the MarketScan database was conducted to assess the association between hypoglycemia and therapy changes (discontinuation or down-titration) among adults receiving SU therapy without insulin. Methods: Patients with the first SU prescription (Rx) (index date) in 2009-2011, ≥ 18 years of age on the index date, and with ≥ 1 year continuous enrollment pre-and postindex were included. Patients were excluded if they received insulin within the 1-year pre-or post-index, had ≥ 2 SUs on the index date, or had type 1, gestational or secondary diabetes. Therapy changes were determined during the 1-year postindex period. Discontinuation occurred when consecutive SU fills were ≥ 90 days apart. Down-titration occurred when an SU fill had a lower equivalent dose than the index dose. Hypoglycemic events were identified using ICD-9 code between the index date and the therapy change or the end of the 1-year post-index period. Cox regression was used to evaluate the association between hypoglycemic events and therapy changes. Results: 97,570 patients were included in the study, of which 50,854 (52.1%) experienced therapy changes within 1-year post-index. Patients with hypoglycemic events were at significantly higher risk for therapy changes (HR= 1.86 [1.75, 1.97]; p< . 01). Specifically, they were 197% more likely to down-titrate (HR= 2.97 [2.53, 3.46]; p< . 01) and 80% more likely to discontinue (HR= 1.80 [1.69, 1.92]; p< . 01). ConClusions: Post-index hypoglycemic events are significantly associated with therapy changes among patients receiving SU without insulin, especially down-titration. PDB122 guIDelIne aDHerence anD control of DIaBetes mellItus wItH co-morBIDItIes In a tertIary-care HosPItal In malaysIa

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