title: Utilization of oral hypoglycemic agents in a drug-insured U.S. population.
abstract: OBJECTIVE
  Clinical trials provide information regarding the safety and efficacy of medications used to manage type 2 diabetes but do not elucidate drug effectiveness in a typical managed care environment. The aim of this study was to characterize "real-world" drug utilization patterns from both a prescriber and a patient perspective.
  
  
  METHODS
  We conducted a retrospective analysis of a large administrative pharmacy claims database, using data on continuously pharmacy benefit-eligible members prescribed oral hypoglycemic agents (OHAs).
  
  
  RESULTS
  The 12-month persistence rate for the OHA cohort was low, ranging from 31% for alpha-glucosidase inhibitors to 60% for metformin; compliance rates varied between 70 and 80%. During the first 12 months of therapy, 36% of the patients remaining on therapy at 12 months had one or more therapy modifications. The mean number of therapy changes increased with the length of patient follow-up, with more than half of all patients experiencing at least one therapy change over the duration of follow-up.
  
  
  CONCLUSIONS
  These findings document the wide variation in utilization patterns associated with pharmacological management of type 2 diabetes, suggesting that opportunity exists to optimize its pharmacological management.
authors.affiliation: The Institute for Effectiveness Research, Bridgewater, New Jersey. Novartis Pharmaceutical Corporation, East Hanover, New Jersey 08807, USA. stephen_boccuzzi@mmmc-tier.com
authors.forename: S J
authors.initials: SJ
authors.lastname: Boccuzzi
authors.forename: J
authors.initials: J
authors.lastname: Wogen
authors.forename: J
authors.initials: J
authors.lastname: Fox
authors.forename: J C
authors.initials: JC
authors.lastname: Sung
authors.forename: A B
authors.initials: AB
authors.lastname: Shah
authors.forename: J
authors.initials: J
authors.lastname: Kim
mesh_terms: D002219:Carbamates / Q000627:therapeutic use; D002839:Chromans / Q000627:therapeutic use; D015331:Cohort Studies; D019992:Databases as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008329:Managed Care Programs; D008687:Metformin / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D045162:Thiazolidinediones; D013997:Time Factors; D000077288:Troglitazone; D014481:United States
chemical_list: D002219:Carbamates; D002839:Chromans; D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D010880:Piperidines; D013453:Sulfonylurea Compounds; D013844:Thiazoles; D045162:Thiazolidinediones; C072379:repaglinide; D008687:Metformin; D000077288:Troglitazone