National Rates of Initiation and Intensification of Antidiabetic Therapy Among Patients With Commercial Insurance.

Abstract

Prompt initiation and intensification of antidiabetic therapy can delay or prevent complications from diabetes. We sought to understand the rates of and factors associated with the initiation and intensification of antidiabetic therapy among commercially insured patients in the U.S. Using 2008-2015 commercial claims linked with laboratory and pharmacy data, we created an initiation cohort with no prior antidiabetic drug use and an HbA_1c ≥8% (64 mmol/mol) and an intensification cohort of patients with an HbA_1c ≥8% (64 mmol/mol) who were on a stable dose of one noninsulin diabetes drug. Using multivariable logistic regression, we determined the rates of and factors associated with initiation and intensification. In addition, we determined the percent of variation in treatment patterns explained by measurable patient factors. In the initiation cohort (<i>n</i> = 9,799), 63% of patients received an antidiabetic drug within 6 months of the elevated HbA_1c test. In the intensification cohort (<i>n</i> = 10,941), 82% had their existing antidiabetic therapy intensified within 6 months of the elevated HbA_1c test. Higher HbA_1c levels, lower generic drug copayments, and more frequent office visits were associated with higher rates of both initiation and intensification. Better patient adherence prior to the elevated HbA_1c level, existing therapy with a second-generation antidiabetic drug, and lower doses of existing therapy were also associated with intensification. Patient factors explained 7.96% of the variation in initiation and 7.35% of the variation in intensification. Approximately two-thirds of patients were newly initiated on antidiabetic therapy, and four-fifths of those already receiving antidiabetic therapy had it intensified within 6 months of an elevated HbA_1c in a commercially insured population. Patient factors explain 7-8% of the variation in diabetes treatment patterns.