Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME‐DM) study. (18th March 2014)

• Record Type: Journal Article
• Authors: Raebel, Marsha A.; Ellis, Jennifer L.; Schroeder, Emily B.; Xu, Stanley; O'Connor, Patrick J.; Segal, Jodi B.; Butler, Melissa G.; Schmittdiel, Julie A.; Kirchner, H. Lester; Goodrich, Glenn K.; Lawrence, Jean M.; Nichols, Gregory A.; Newton, Katherine M.; Pathak, Ram D.; Steiner, John F.
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 23:Number 7(2014:Jul.)
• Page Start: 699
• Page End: 710
• Publication Date: 2014-03-18
• Subjects: Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.3610
• Languages: English
• ISSNs: 1053-8569

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="pds3610-sec-0001" sec-type="section"> <title>Purpose</title> <p>Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients.</p> </sec> <sec id="pds3610-sec-0002" sec-type="section"> <title>Methods</title> <p>This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31–365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time‐dependent variable.</p> </sec> <sec id="pds3610-sec-0003" sec-type="section"> <title>Results</title> <p>Among 41 233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (<1%). HbA1c% was strongly associated with intensification (adjusted hazard ratios [HR] 1.59, 3.62, 4.44, and 5.52 for HbA1c 6.5% to <7%, 7% to <7.5%, 7.5 to <8%, and ≥8%, respectively, all <italic>P</italic> < 0.001, compared with HbA1c < 6.5%). In patients initially on monotherapy, age modified the HbA1c effect: at HbA1c < 7%, the HR differed little between middle‐aged and older patients; at HbA1c ≥ 7%, the HR decreased with older age (e.g., age 40–49 years and HbA1c ≥ 8%: HR 8.14; age ≥ 80 years and HbA1c ≥ 8%: HR 4.44; compared with age ≥ 80 years and HbA1c < 6.5%). Within 1 year, 84.3% achieved HbA1c < 8%; 65.1% achieved HbA1c < 7%.</p> </sec> <sec id="pds3610-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Clinicians appear to be applying treatment intensification guidelines and individualizing therapy by considering patient age, achieving glycemic control among most incident diabetes patients. Copyright © 2014 John Wiley & Sons, Ltd.</p> </sec> </abstract>