title: Trends in the prescribing of oral agents for the management of type 2 diabetes mellitus in the United States, 1990-2001: does type of insurance influence access to innovation?
abstract: The objectives of the present study were (1) to discern trends in the prescribing of oral pharmacotherapy for the management of type 2 diabetes mellitus (DM) in the United States during the years 1990 through 2001 and (2) to examine the mediating role of primary health insurance coverage on patients' access to pharmaceutical innovation for the management of type 2 DM.
  
  
  
  Data from the US National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 2001 were used for this analysis.
  
  
  
  National estimates of the number of office-based visits documenting a diagnosis of type 2 DM and the prescribing of an oral medication for glycemic control increased from 7 871 283 in 1990 to 13 730 886 in 2001 (a 74.4% increase). A significantly higher proportion of patients covered by private health insurance were prescribed a newer agent, either alone or as part of a combination regimen of oral agents, as compared to patients covered by either Medicare or Medicaid (chi(2) < or = .001).
  
  
  
  Over the time frame of 1995 through 2001, access to pharmaceutical innovation for the management of type 2 DM was mediated by the patient's primary source of health insurance coverage. Future research will need to discern the effect of observed differences in the prescribing of oral agents for the management of type 2 DM on both clinical and economic outcomes and, in light of ongoing discussion regarding health care reform in the United States, to foster clinically rational and equitable access to pharmaceutical innovation.
authors.affiliation: The Pharmacoeconomics and Pharmacoepidemiology Research Unit, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)|Department of Health Policy and Administration, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Skaer
authors.affiliation: The Pharmacoeconomics and Pharmacoepidemiology Research Unit, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)|Department of Health Policy and Administration, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)|Department of Statistics, Washington State University, Pullman (Dr Sclar)
authors.forename: David A
authors.initials: DA
authors.lastname: Sclar
authors.affiliation: The Pharmacoeconomics and Pharmacoepidemiology Research Unit, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)|Department of Health Policy and Administration, Washington State University, Pullman (Dr Skaer, Dr Sclar, Ms Robison)
authors.forename: Linda M
authors.initials: LM
authors.lastname: Robison
mesh_terms: D000284:Administration, Oral; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004358:Drug Therapy / Q000191:economics / Q000639:trends; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D014481:United States
chemical_list: D007004:Hypoglycemic Agents