pharmacoepidemiology and drug safety 2014; 23: 699–710 Published online 17 March 2014 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pds.3610
ORIGINAL REPORT
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study Marsha A. Raebel1,2*, Jennifer L. Ellis1, Emily B. Schroeder1,3, Stanley Xu1, Patrick J. O’Connor4, Jodi B. Segal5, Melissa G. Butler6, Julie A. Schmittdiel7, H. Lester Kirchner8, Glenn K. Goodrich1, Jean M. Lawrence9, Gregory A. Nichols10, Katherine M. Newton11, Ram D. Pathak12 and John F. Steiner1 1
Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA 3 University of Colorado School of Medicine, Aurora, CO, USA 4 HealthPartners Institute for Education and Research, Minneapolis, MN, USA 5 Johns Hopkins University, Baltimore, MD, USA 6 Center for Health Research Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA 7 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA 8 Geisinger Health System, Danville, PA, USA 9 Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA 10 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA 11 Group Health Research Institute, Seattle, WA, USA 12 Marshfield Clinic Research Foundation, Marshfield, WI, USA 2
ABSTRACT Purpose Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients. Methods This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31–365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time-dependent variable. Results Among 41 233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (
ORIGINAL REPORT
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study Marsha A. Raebel1,2*, Jennifer L. Ellis1, Emily B. Schroeder1,3, Stanley Xu1, Patrick J. O’Connor4, Jodi B. Segal5, Melissa G. Butler6, Julie A. Schmittdiel7, H. Lester Kirchner8, Glenn K. Goodrich1, Jean M. Lawrence9, Gregory A. Nichols10, Katherine M. Newton11, Ram D. Pathak12 and John F. Steiner1 1
Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA 3 University of Colorado School of Medicine, Aurora, CO, USA 4 HealthPartners Institute for Education and Research, Minneapolis, MN, USA 5 Johns Hopkins University, Baltimore, MD, USA 6 Center for Health Research Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA 7 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA 8 Geisinger Health System, Danville, PA, USA 9 Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA 10 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA 11 Group Health Research Institute, Seattle, WA, USA 12 Marshfield Clinic Research Foundation, Marshfield, WI, USA 2
ABSTRACT Purpose Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients. Methods This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31–365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time-dependent variable. Results Among 41 233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (
