Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study

• Published in: Pharmacoepidemiology and drug safety 2014-07, Vol.23 (7), p.699-710
• Main 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.
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Aged; Aged, 80 and over; antihyperglycemic medication; Biological and medical sciences; Blood Glucose - drug effects; Clinical trial. Drug monitoring; Cohort Studies; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Drug therapy; Drug Therapy, Combination; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General pharmacology; Glycated Hemoglobin A - metabolism; glycosylated hemoglobin; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; incident diabetes; Insulin - administration & dosage; Insulin - therapeutic use; Male; Medical sciences; metformin; Middle Aged; Patients; pharmacoepidemiology; Pharmacology. Drug treatments; Practice Guidelines as Topic; Proportional Hazards Models; Retrospective Studies; sulfonylurea; Time Factors; treatment intensification; United States
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.3610

ABSTRACT 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 (