Lowest adjusted risk of switching and highest intensification risk for patients prescribed sufonylureas
Most patients with type 2 diabetes initiating antidiabetic medication (ADM) experience treatment modification within one year, according to a study published in the December issue of the American Journal of Managed Care.
David T. Liss, Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a retrospective cohort study to describe changes in ADM use after initiation of noninsulin second-line therapy. Adults with type 2 diabetes who initiated one of five index ADM classes were analyzed; three treatment modification outcomes were assessed over 12-month follow-up.
The researchers found that 63.6 percent of the 82,624 included adults experienced any treatment modification. The most common modification was discontinuation (38.6 percent), especially among those prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs; 50.3 percent). Switching and intensification occurred in 5.2 and 19.8 percent of patients, respectively. In adjusted analyses, discontinuation risk was higher among patients prescribed dipeptidyl peptidase 4 inhibitors and GLP-1 RAs compared with those prescribed sulfonylureas (hazard ratios, 1.07 and 1.28, respectively).
Higher risks of switching and lower risks of intensification were seen for all other index ADM classes compared with sulfonylureas. Higher risk of all modifications was seen in association with younger age group and female sex. Index prescription by an endocrinologist was associated with lower discontinuation risk and higher intensification risk compared with index prescription by a family medicine or internal medicine physician.
“Future research is needed to improve our understanding of barriers to ADM adherence among patients who discontinue second-line therapy,” the authors write.
One author disclosed ties to the pharmaceutical industry.
