Transitions of Care for People with Type 2 Diabetes: Utilization of Antihyperglycemic Agents Pre- and Post-Hospitalization. Issue 1 (March 2016)

• Record Type: Journal Article
• Authors: Montejano, Leslie; Vo, Lien; McMorrow, Donna
• Is Part Of: Diabetes therapy. Volume 7:Issue 1(2016)
• Page Start: 91
• Page End: 103
• Publication Date: 2016-03
• Subjects: Antihyperglycemic agents -- Hospitalization -- Transitions of care -- Treatment -- Type 2 diabetes mellitus; Diabetes -- Periodicals; Diabetes -- Treatment -- Periodicals; Endocrinology -- Periodicals; 616.462005
• DOI: 10.1007/s13300-015-0148-5
• Languages: English
• ISSNs: 1869-6961

Abstract

Abstract Introduction Little research to date has examined antihyperglycemic agent (AHA) utilization among patients with type 2 diabetes mellitus (T2DM) around transitions of care from inpatient to outpatient settings. Discontinuity of care between inpatient and outpatient settings has been associated with adverse clinical outcomes, so a better understanding of AHA treatment patterns is important. Methods This retrospective study assessed AHA utilization among a sample of United States adults with a T2DM diagnosis listed on an inpatient admission during 2010–2012 in the MarketScan® Hospital Drug database (Truven Health Analytics). AHA use while hospitalized was measured from inpatient medication administration records in that database. AHA use pre- and post-hospitalization was assessed from outpatient retail and mail order pharmacy claims in the MarketScan Commercial and Medicare Supplemental databases, which contain de-identified insurance claims from large employers and health plans. The hospital and claims databases are linked, allowing patients to be followed across transitions of care. Results The study sample (N = 8144) was 53% male, with a mean age of 66 years. Twenty-one percent had no T2DM diagnosis or claims for AHAs in the 90-day pre-hospitalization period suggesting they may have been newly diagnosed at the time of admission. Most (83%) patients used AHAs while hospitalized, but the proportions with AHA claims 30 days pre- and post-hospitalization were only 53% and 40%, respectively. Biguanides and sulfonylureas were the most common outpatient agents. Most (70%) patients who had no AHA utilization pre-hospitalization continued to have no AHA utilization post-hospitalization. About half the patients with AHA claims pre-hospitalization did not have any AHA claims post-discharge. Conclusion Further research is warranted to explore the reasons why AHAs are not continued following hospital discharge. Inadequate treatment of T2DM remains an issue before and after hospitalization; inpatient stays represent an important and frequently missed opportunity to assess and optimize care for these patients. Funding Janssen Scientific Affairs, LLC.