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Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME‐DM) study
Author(s) -
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.
Publication year - 2014
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3610
Subject(s) - medicine , diabetes mellitus , hazard ratio , proportional hazards model , retrospective cohort study , diabetes management , pharmacoepidemiology , insulin , cohort , type 2 diabetes , endocrinology , confidence interval , pharmacology , medical prescription
Purpose 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. Methods 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. Results 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 P < 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%. Conclusions 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.