Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006–2013

Abstract

OBJECTIVETo 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 METHODSUsing 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).RESULTSFrom 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).CONCLUSIONSDuring 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.

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

“…Rising trends in severe hypoglycaemia (resulting in emergency department visit or hospital admissions) have been reported in recent years for several high-SDI countries (USA, Canada, Japan, England) [14][15][16][17][18]. Most of these studies revealed a peak (2007 in the USA [14], 2006 in Canada and 2010 in Japan and England) followed by more stable trends.…”

Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes

“…If both categories were used in tandem, as some have proposed, the combined costs could easily exceed the total expenditures for all retail prescription drugs in the U.S. as of 2014 (33)! Our group recently reported that while spending on diabetes medications has increased dramatically over the past decade, the mean HbA 1c and rates of hypoglycemia have not changed appreciably (12). These data suggest, at the very least, that the value of diabetes therapy must be carefully considered, especially if any major changes in traditional strategies are being contemplated.…”

“…This body of evidence, along with metformin's low cost and general good tolerability, catapulted the drug in less than a decade to be the most commonly used oral antihyperglycemic agent in the U.S. (12). Most treatment guidelines, including those from the American Diabetes Association/European Association for the Study of Diabetes (13) and the International Diabetes Federation (14), suggest metformin be used as the first-line therapy after diet and exercise, barring any prevailing contraindications.…”

Effect of Nutrition on Statural Growth

“…It has been shown in rats that the systemic injection of insulin induces body growth [30, 33]. Furthermore, in vitro studies have demonstrated a stimulatory effect of insulin on chondrocyte proliferation [34-37] and variable effects on chondrocyte differentiation [35-38]. …”