title: Medicaid managed care: disparities in the use of thiazolidinediones compared with metformin.
abstract: OBJECTIVE
  To identify patient characteristics that are associated with the incidence of thiadolidinediones (TZDs) or metformin prescnbing in Medicaid managed care plans.
  
  
  METHODS
  We utilized a retrospective cohort study design. Two-and-one-half years of prescription claims of Medicaid managed care organizations (MCOs) patients who were new utilizers of metformin or TZDs were analyzed using univariate, bivariate and multivariate models. Multivariate logistic regression models were built to assess the combined effect of all variables on the likelihood of incident use of TZDs or metformin.
  
  
  RESULTS
  Claims for 3,041 patients were analyzed for the period between January 15, 2000 and June 15, 2002. African Americans and urban residents were less likely to be started on TZDs (OR = 0.678, 95% C1 = 0.830-1.206; OR = 0.579, 95% CI = 0.479-0.699, respectively). Advanced age, preexisting comorbidities and diabetes complications, and prior use of other oral diabetes drugs or insulin were predictors of increased likelihood of TZD initiation.
  
  
  CONCLUSIONS
  Race, age, residential setting, preexisting comorbidities and diabetes complications, other oral diabetes drug use, and insulin use are statistically significant predictors of initial prescribing of TZD or metformin in a Medicaid MCO population. Findings can potentially inform the management of diabetes in managed care so as to improve outcomes.
authors.affiliation: Outcomes Research/Epidemiology Center on Drugs and Public Policy University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. fshaya@rx.umaryland.edu
authors.forename: Fadia T
authors.initials: FT
authors.lastname: Shaya
authors.forename: James Y
authors.initials: JY
authors.lastname: Shin
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullins
authors.forename: Hugh O
authors.initials: HO
authors.lastname: Fatodu
authors.forename: Anna
authors.initials: A
authors.lastname: Gu
authors.forename: Elijah
authors.initials: E
authors.lastname: Saunders
mesh_terms: D015331:Cohort Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards* / Q000639:trends; D008484:Medicaid / Q000592:standards* / Q000639:trends; D008687:Metformin / Q000627:therapeutic use*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D045162:Thiazolidinediones / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D008687:Metformin