Visual Abstract
Background: The ADA Pharmacotherapy Guidelines for type 2 diabetes (T2D) recommend patient-centric prescribing based on individual characteristics such as prevalent ASCVD, CKD, heart failure (HF), hypoglycemia (hypo), and obesity.
Method: Analysis of health care claims in patients with T2D (IBM® MarketScan® 2007 to 2019 Commercial [com] and Medicare[med] Supplemental Databases). Prescription claims were evaluated for the year 2019 (N=580,741). Claims since 2007 characterized patient history. Patients were categorized into risk/no risk groups (2019 ADA/EASD Consensus Statement: ASCVD, CKD, HF, hypo, or obesity). The medication use rate in risk vs. no risk groups, the overall mean, or com vs. med cohorts was tested using bootstrapping.
Results: A large proportion of patients with T2D fit into multiple risk groups; overlap was more common in Med data. Patients with history of hypo or HF had the greatest overlap. Metformin, GLP-1, and SGLT2 use were more common in the Com cohort. SU and DPP-4 use were higher in Med data. The guideline-recommended therapy use was more prevalent in the CKD, ASCVD groups in Com cohort, and in obesity groups in both cohorts vs. no risk group. SGLT2 use rate was lower in the HF group compared to cohort average in both cohorts.
Conclusion: Prevalence of guideline-aligned treatment use in 2019 was low, particularly since many patients fit into multiple risk groups with established treatment benefits.
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.
