Long-Term Glycemic Control and Pharmacotherapy in Type 2 Diabetes Mellitus: A Descriptive Analysis of 10-Year Trends in a Statewide Sample.

BACKGROUND

Little is known about prescribing and glycemic control trends for Type 2 diabetes (T2D) drug classes across populations.

OBJECTIVE

The aim of this study is to assess long-term glycemic control in a statewide sample prescribed with T2D drugs.

DESIGN

Descriptive analysis of retrospective 10-year cohort data from the Indiana Health Information Exchange in the United States.

PARTICIPANTS

Adults with T2D were prescribed at least one diabetes drug.

MAIN MEASURES: Glycemic success is the number of A1c < 7% for age < 65 or <8% for age ≥65/(number of A1c tests) in any given year. Prescription rate is the number of subjects with a drug ordered in a year, divided by the population size in that year. >

RESULTS

Glycemic success was 60%, with year-to-year changes of 0%-1%. The prevalence of glycemic success was greater for females (mean of 62%-64%) than males (57%-59%); participants aged 65 or above (75%-89%) versus younger patients (43%-62%); and White (61%-63%) versus Black (51%-54%) patients. Biguanides (56%-63%) were most frequently prescribed, followed by sulfonylureas (29%-33%) and fast-acting and long-acting insulins (30%-32%). Black participants had more insulin prescriptions (47%-50%, vs. non-Black, 9%-49%%). Newer drugs were more frequently prescribed for White than non-White patients: 10%-17% versus 1.3%-17% for dipeptidyl peptidase 4 inhibitors; < 1%-9% versus 0.2%-8% for sodium/glucose cotransporter 2 inhibitors; and 5.3%-12% versus 1%-12% for glucagon-like peptide receptor agonists. A greater number of diabetes drug classes ever prescribed was associated with lower glycemic success (1 class with 76%, vs. 2-3 classes with 55%, vs. 4-9 classes with 37%).

CONCLUSIONS

Glycemic control did not substantively improve over a 10-year period, despite the availability of new medications. Racial minorities received fewer prescriptions for newer drugs. Future research should examine factors contributing to prescription pattern differences and barriers to glycemic control.