1237-P: Descriptive Analysis of Long-Term Glycemic Control and Pharmacotherapy in Type 2 Diabetes: Ten-Year Trends in 308,4Indiana Adults

The purpose of this study was to assess success rates of long-term glycemic control and diabetes drug prescriptions by gender, age and race in a large, state-wide, integrated, electronic health record database in Indiana. Descriptive analysis of a retrospective cohort of 308,4adults with type 2 diabetes observed from 20to 2018 was conducted. The success rate for glycemic control (A1c <7 [<65 y/o] or <8 [>=65 y/o]) was defined as (number of A1c tests meeting target) / (number of A1c tests) in any given year. Sample characteristics included gender, age, race, and diabetes drug prescription rate for twelve classes of diabetes drugs. Analysis of 876,656 year-level observations showed the success rate of glycemic control was steady at 60% with year-to-year change of 0-1% since 2009. It was greater for females (62-64%) than males (57-59%) ; patients aged 65 or above (75-89%) than those below (43-62%) ; and whites (61-63%) than blacks (51-54%) . Biguanides (56-63% = subject n with orders of biguandes in x year/ population n in x year) were most frequently prescribed, followed by sulfonylurea (29-33%) , fast-acting and long-acting insulin (29-32%) . Blacks had more insulin prescription (47-53%) regardless of age group. Costlier drugs were more frequently prescribed among whites vs. non-white: 0.6-1.2% vs. 0.5-0.8 for meglitinides; 10.3-16.7% vs. 1.3-17.3% for DPP-4; 0.5-9.3% vs. 0.2-8.0 for SGLT2i; and 5.3-12.15% vs. 1-11.5% for GLP-1. For blacks who were prescribed insulin (44-53%) , the success rate for glycemic control was lower than for whites (38-43% vs. 46-50%) . The success of longitudinal glycemic control did not improve over a 10-year period among 308,4adults with type 2 diabetes in Indiana. Racial minorities received notably fewer prescriptions for higher-priced drugs such as meglitinide, DPP4, SGLT2, and GLP-1.