Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study

Objective: The goal of this study was to describe medication usage patterns in patients with type 2 diabetes mellitus (T2DM) initiating treatment with non-insulin antidiabetic drugs (NIADs), basal insulin, or prandial/mixed insulin using real-world data. Research design and methods: A retrospective analysis using the Truven Health MarketScan Research Databases was conducted to identify adults (>= 18 years) with T2DM from 2006 to 2012. Patients were categorized into four cohorts based on diabetes treatment. Cohort 1 (n=597 664) consisted of newly diagnosed patients who did not receive any treatment, cohort 2 (n=342 511) included NIAD initiators, cohort 3 (n=99 578) included basal insulin initiators, and cohort 4 (n=62 876) included prandial/mixed insulin initiators. Patients transitioned out of a cohort once they met the criteria for the next one. Results: Patients in cohort 2 were younger (56.2 years, SD +/- 12.1) than patients in cohorts 1, 3, and 4 (58 years, SD +/- 0.75). Metformin was the most commonly prescribed drug in cohort 2 patients. Basal insulin usage decreased from 71% in year 1 to 47% in year 4, in cohort 3 patients. Approximately one-third of these patients switched to prandial/mixed insulin each year. In cohort 4, the usage of prandial/mixed insulin decreased to 61% by year 4. Use of basal insulin and NIAD remained common in this group. Mean glycosylated hemoglobin (HbA1c) values decreased by similar to 1% for each of the treatment cohorts following treatment initiation and remained stable during followup. All-cause and diabetes-related medical costs were highest for patients in cohorts 3 and 4. Conclusions: Overall, our findings demonstrate that treatment intensification was low in all study cohorts despite elevated HbA1c levels during preindex and follow-up period.