Background: Newer treatment options for type 2 diabetes (T2D) and emerging evidence of treatment-specific benefits for ASCVD, CKD, heart failure (HF), hypoglycemia, and obesity provide opportunities for individualizing treatment choices. We used claims data to examine how T2D treatment patterns have changed in recent years as clinical trial data and updated guidelines have emerged.
Method: A retrospective observational study of T2D patients in a health insurance claims database (IBM® MarketScan® 2007 to 2019 Commercial and Medicare Databases). Medication use by class was examined from Jan 2015 through Dec 2019. Data since 2007 were used to establish disease history and categorize individuals according to the ADA/EASD Consensus Statement (2019): ASCVD, CKD, HF, hypoglycemia, and obesity defined risk groups. Alignment of risk group with treatment recommendation was evaluated by comparing use rates in the groups with and without risk. A GEE model was fit with guideline alignment as the dependent variable. The slope parameter and the area under the curve were calculated on the probability scale.
Results: Use of guideline-recommended therapies in the risk groups increased in both cohorts from 2015 to 2019. The Commercial cohort showed better alignment vs. the Medicare cohort over all years. Guideline-recommended therapy use in 2019 was highest in the Commercial CKD and obesity groups (39.2%; 37.6 %) with 5 year growth rates of 74.5% and 54.9%; and lowest in Medicare HF and CKD groups (16.6%; 18.5% ), but showing rapid 5 year growth (145.5% and 132.2% respectively). Use of SU in the hypoglycemia risk group decreased over time, but at comparable rates to those without the risk. The HF risk group was less likely to receive guideline recommended therapies vs. no HF risk.
Conclusion: The data suggest there is considerable room for improvement in individualizing therapies according to ADA risk grouping. Improving alignment through more targeted prescribing could further enhance outcomes without increasing overall use.
J. P. Bae: Employee; Self; Eli Lilly and Company. D. Liu: Employee; Self; Eli Lilly and Company. C. Chinthammit: Employee; Self; Eli Lilly and Company. Z. A. Kadziola: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. K. Boye: Employee; Self; Eli Lilly and Company, Employee; Spouse/Partner; Eli Lilly and Company. K. J. Mather: Employee; Self; Eli Lilly and Company.