Adoption of New Glucose-Lowering Medications in the U.S.-The Case of SGLT2 Inhibitors: Nationwide Cohort Study.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 100889084 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8593 (Electronic) Linking ISSN: 15209156 NLM ISO Abbreviation: Diabetes Technol Ther Subsets: MEDLINE
    • Publication Information:
      Original Publication: Larchmont, NY : Mary Ann Liebert, Inc., c1999-
    • Subject Terms:
      Practice Patterns, Physicians'*; Diabetes Mellitus, Type 2/*drug therapy ; Hypoglycemic Agents/*therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/*therapeutic use; Adult ; Age Factors ; Aged ; Benzhydryl Compounds/therapeutic use ; Canagliflozin/therapeutic use ; Cohort Studies ; Drug Prescriptions ; Female ; Glucosides/therapeutic use ; Humans ; Male ; Medicare ; Middle Aged ; Retrospective Studies ; United States
    • Abstract:
      Background: High-quality diabetes care is evidence-based, timely, and equitable. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are the most recently approved class of glucose-lowering medications with additional cardio- and renal-protective benefits and low risk of hypoglycemia. Cardiovascular and kidney disease are among the most common chronic diabetes complications, whereas hypoglycemia is the most prevalent adverse effect of glucose-lowering therapy. We examine the sociodemographic and clinical factors associated with early SGLT2i initiation and appropriateness of use based on contemporaneous scientific evidence. Materials and Methods: Retrospective analysis of medical and pharmacy claims data from OptumLabs ® Data Warehouse for commercially insured and Medicare Advantage adult beneficiaries with diabetes types 1 and 2, who filled any glucose-lowering medication between January 1, 2013 and December 31, 2016. Demographic (age, sex, race, income), clinical (comorbidities), and insurance-related factors affecting first prescription for a SGLT2i were examined using multivariable logistic regression. Results: Among 1,054,727 adults with pharmacologically treated diabetes, 7.2% ( n  = 75,500) initiated a SGLT2i. Patients with prior myocardial infarction (MI) (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.91-0.96), heart failure (HF) (OR: 0.93, 95% CI: 0.91-0.94), kidney disease (OR: 0.80, 95% CI: 0.78-0.81), and severe hypoglycemia (OR: 0.96, 95% CI: 0.94-0.98) were all less likely to start a SGLT2i; P  < 0.001 for all. SGLT2i were also less likely to be started by patients ≥75 years (OR: 0.57, 95% CI: 0.55-0.59, vs. 18-44 years), Black patients (OR: 0.93, 95% CI: 0.91-0.95, vs. White), and those with Medicare Advantage insurance (OR: 0.63, 95% CI: 0.62-0.64, vs. commercial). Conclusions: Younger, healthier, non-Black patients with commercial health insurance were most likely to start taking SGLT2i. Patients with MI, HF, kidney disease, and prior hypoglycemia were less likely to use SGLT2i, despite evidence supporting their preferential use in these patients. Efforts to address this treatment-risk paradox may help improve health outcomes among patients with type 2 diabetes.
    • References:
      Endocr Pract. 2016 Jan;22(1):84-113. (PMID: 26731084)
      N Engl J Med. 2016 Jul 28;375(4):323-34. (PMID: 27299675)
      JAMA Intern Med. 2014 Dec;174(12):1955-62. (PMID: 25347323)
      N Engl J Med. 2017 Aug 17;377(7):644-657. (PMID: 28605608)
      Am J Manag Care. 2012 Nov;18(11):721-6. (PMID: 23198714)
      J Card Fail. 2019 Aug;25(8):584-619. (PMID: 31174952)
      Endocr Pract. 2019 Jan;25(1):69-100. (PMID: 30742570)
      Endocr Pract. 2016 Mar;22(3):315-22. (PMID: 26523624)
      J Clin Endocrinol Metab. 2016 Jan;101(1):44-51. (PMID: 26580234)
      Diabetes Care. 2015 Jul;38(7):1181-8. (PMID: 26049551)
      Diabetes Care. 2019 Jan;42(Suppl 1):S34-S45. (PMID: 30559230)
      Diabetes Care. 2014 Jan;37 Suppl 1:S14-80. (PMID: 24357209)
      Diabetes Care. 2018 May;41(5):917-928. (PMID: 29567642)
      Diabetes Care. 2015 Mar;38(3):412-9. (PMID: 25271207)
      JAMA. 2004 Apr 21;291(15):1864-70. (PMID: 15100205)
      Diabetes Care. 2019 Jan;42(Suppl 1):S90-S102. (PMID: 30559235)
      J Diabetes Metab Disord. 2015 Oct 09;14:78. (PMID: 26457255)
      Endocr Pract. 2013 May-Jun;19(3):536-57. (PMID: 23816937)
      N Engl J Med. 2019 Jan 24;380(4):347-357. (PMID: 30415602)
      Diabetes Metab. 2018 Nov;44(5):410-414. (PMID: 29506779)
      J Clin Endocrinol Metab. 2016 Jan;101(1):157-66. (PMID: 26580237)
      Drugs Aging. 2006;23(1):71-81. (PMID: 16492071)
      Diabetes Care. 2018 Dec;41(12):2669-2701. (PMID: 30291106)
      BMC Health Serv Res. 2012 Mar 08;12:56. (PMID: 22401169)
      Diabetes Care. 2015 Jan;38(1):6-8. (PMID: 25538309)
      Health Serv Res. 2007 Aug;42(4):1499-519. (PMID: 17610435)
      Diabetes Care. 2018 Jan;41(1):69-78. (PMID: 29109299)
      Diabetes Care. 2015 Sep;38(9):1687-93. (PMID: 26078479)
      Diabetes Care. 2014 May;37(5):1480-3. (PMID: 24595630)
      Med Care. 2016 Jul;54(7):725-32. (PMID: 27116109)
      J Clin Pharm Ther. 2005 Apr;30(2):145-52. (PMID: 15811167)
      JAMA. 2005 Sep 14;294(10):1240-7. (PMID: 16160132)
      J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716)
      Diabetes Care. 2015 Sep;38(9):1680-6. (PMID: 26203064)
      Diabetes Care. 2013 Apr;36(4):914-21. (PMID: 23193215)
      N Engl J Med. 2015 Nov 26;373(22):2117-28. (PMID: 26378978)
      J Racial Ethn Health Disparities. 2017 Dec;4(6):1147-1158. (PMID: 27928769)
      Am J Med. 2003 Dec 15;115(9):715-20. (PMID: 14693324)
      Circulation. 2018 Apr 3;137(14):1450-1459. (PMID: 29133607)
      Diabetes Care. 2004 Aug;27(8):1879-84. (PMID: 15277411)
      Med Care. 2003 Aug;41(8):895-908. (PMID: 12886170)
      Diabetes Care. 2015 Dec;38(12):2258-65. (PMID: 26486192)
      Diabetes Obes Metab. 2015 Oct;17(10):928-35. (PMID: 26080652)
      J Clin Epidemiol. 2005 Jan;58(1):98-102. (PMID: 15649677)
      Endocr Pract. 2015 Apr;21 Suppl 1:1-87. (PMID: 25869408)
      Nutr Metab Cardiovasc Dis. 2017 Dec;27(12):1108-1113. (PMID: 29174031)
      Health Aff (Millwood). 2014 Jul;33(7):1187-94. (PMID: 25006145)
      PLoS One. 2015 Nov 06;10(11):e0141085. (PMID: 26544192)
      Pharmacoepidemiol Drug Saf. 2018 Oct;27(10):1053-1059. (PMID: 29292555)
      Diabetes Care. 2017 Apr;40(4):468-475. (PMID: 27659408)
      Curr Diab Rep. 2018 Jun 21;18(8):53. (PMID: 29931579)
      Circulation. 2014 Feb 4;129(5):587-97. (PMID: 24334175)
    • Grant Information:
      K23 DK114497 United States DK NIDDK NIH HHS; U01 FD004585 United States FD FDA HHS; R56 HL130496 United States HL NHLBI NIH HHS; R01 HS025164 United States HS AHRQ HHS; U19 HS024075 United States HS AHRQ HHS; R01 HS025402 United States HS AHRQ HHS; R01 HS022882 United States HS AHRQ HHS; R03 HS025517 United States HS AHRQ HHS; P01 AG005842 United States AG NIA NIH HHS; R01 HL131535 United States HL NHLBI NIH HHS; U01 FD005938 United States FD FDA HHS
    • Contributed Indexing:
      Keywords: Administrative claims data; Diabetes mellitus; Evidence-based medicine; Health services research; Pharmacoepidemiology; SGLT2 inhibitor
    • Accession Number:
      0 (Benzhydryl Compounds)
      0 (Glucosides)
      0 (Hypoglycemic Agents)
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      0SAC974Z85 (Canagliflozin)
      1ULL0QJ8UC (dapagliflozin)
      HDC1R2M35U (empagliflozin)
    • Publication Date:
      Date Created: 20190817 Date Completed: 20200526 Latest Revision: 20240729
    • Publication Date:
      20240729
    • Accession Number:
      PMC7207017
    • Accession Number:
      10.1089/dia.2019.0213
    • Accession Number:
      31418588