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Diabetes therapy initiation, intensification rates growing

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June 15, 2018

Lauren Gilstrap
Lauren G. Gilstrap

About a third of patients with uncontrolled diabetes have no prescribed antidiabetes medications and about 15% are prescribed inadequate medications; however, rates of initiation and intensification of diabetes therapies increased between 2008 and 2015, according to a study published in Diabetes Care.

Although individual patient characteristics accounted for less than 10% of variation in treatment, higher HbA1c level, lower drug copays and more frequent office visits were associated with greater likelihood of initiating or intensifying therapy, according to the researchers.

“We are better at starting and up-titrating antidiabetic [therapy] than we were a decade ago,” Lauren G. Gilstrap, MD, MPH, fellow in cardiovascular medicine at Brigham and Women’s Hospital and research fellow in the department of health care policy at Harvard Medical School, told Endocrine Today. “In this study, we found that two-thirds of people who were newly initiated on antidiabetic therapy and four-fifths already on therapy had it up-titrated within 6 months of an elevated HbA1c of at least 8%.”

Researchers used data compiled between 2008 and 2015 from a nationally representative commercial insurer to assemble a cohort of U.S. adults with a baseline HbA1c of at least 8%. Researchers then divided patients into two groups. The initiation cohort consisted of 9,799 individuals who had no prescription for an antidiabetic drug for at least 6 months prior to the baseline HbA1c, whereas the intensification cohort was made of 10,941 individuals who were prescribed a stable dose of one noninsulin antidiabetic drug during that time. Researchers used multivariable logistic regression to calculate the rates of initiation and intensification. Measurable baseline patient characteristics — including age, sex, socioeconomic status, geographic region, population density and comorbidities — were considered to determine whether these factors played a role in variation of treatment patterns in both the initiation or intensification of antidiabetic therapy.

Among the initiation cohort, 63% of patients received an antidiabetic drug within the 6 months following the HbA1c test. Most initiation occurred within the first 3 months of the test (84%). The rate of initiation increased by 20% between 2008 and 2015 (49% to 69%; P < .01).

Among the intensification cohort, 82% of participants had diabetes therapy intensified within 6 months following the elevated HbA1c test, with the most intensification also occurring within the first 3 months (89%). The rate of intensification increased by 10% between 2008 and 2015 (76% to 86%; P < .01).


Researchers also determined that the average generic drug copayment was lower for patients who initiated therapy than those who did not ($9.66 vs. $10.23; P < .001) and lower among those who intensified therapy compared with those who did not ($9.37 vs. $9.85; P < .001). Therapy initiation was associated with more frequent office visits within 6 months (OR = 1.15; 95% CI, 1.12-1.17), as was intensification of therapy (OR = 1.1; 95% CI, 1.08-1.13).

Furthermore, each percentage increase in index HbA1c was associated with a greater likelihood of initiating diabetes therapy within 6 months (OR = 1.15; 95% CI, 1.12-1.18) or of intensifying therapy (OR = 0.97; 95% CI, 0.95-0.98).

Researchers concluded that the rates of initiation and intensification did not vary significantly based on patient characteristics (which explained 7.96% and 7.35% of the variation, respectively).

“There is still room for improvement,” Gilstrap said. “We believe [these] observations provide clues as to where and how additional progress can be made in this area.” – by Melissa J. Webb

For more information:

Lauren G. Gilstrap, MD, MPH, can be reached at

Disclosures: The study was funded in part by grants from Merck Sharpe & Dohme and the Pharmaceutical Research and Manufacturers of America.



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