DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and post-marketing outcomes trials found cardiovascular and renal benefits with GLP-1RA and SGLT2i use. Using 2013-2016 data, we previously found low and delayed early adoption of SGLT2i among Medicare Advantage (MA) beneficiaries compared to commercial beneficiaries, despite similar formulary coverage. With greater experience using these medications and emerging evidence supporting their preferred use by patients with comorbidities, prescribing patterns may have changed. Using OptumLabs Data Warehouse, a de-identified dataset of commercial and MA beneficiaries, we examined the proportions of pharmacologically-treated adults with type 2 diabetes with commercial vs. MA insurance who filled a DPP-4i, GLP-1RA, or SGLT2i each quarter between 2013-2018. We found significant differences across medications and health plans (Figure). Overall, after adjusting for age, gender, race/ethnicity, baseline medications, year, prescriber specialty, and comorbidities, the odds of DPP-4i, GLP-1RA, and SGLT2i use were significantly lower for MA vs. commercial beneficiaries: OR 0.61 (95% CI 0.60-0.63), 0.45 (95% CI 0.44-0.46), and 0.31 (95% CI 0.30-0.31), respectively. These findings call for better understanding of non-clinical factors contributing to treatment decisions.


R.G. McCoy: None. H. Van Houten: None. J. Ross: Research Support; Self; Centers for Medicare and Medicaid Services, Janssen Pharmaceuticals, Inc., U.S. Food and Drug Administration. P. Karaca-Mandic: None. V.M. Montori: None. N. Shah: None.


National Institutes of Health (K23DK114497); Agency for Healthcare Research and Quality (1U19HS024075, R01HS025164)

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