title: Initial antihyperglycemic drug therapy among 241 327 adults with newly identified diabetes from 2005 through 2010: a surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) study.
abstract: BACKGROUND
  Among adults with incident diabetes, data are lacking about first antihyperglycemic initiation and whether medication choice aligns with recommendations.
  
  
  OBJECTIVE
  To identify predictors of initiating any antihyperglycemic, and specifically sulfonylurea versus metformin.
  
  
  METHODS
  This retrospective cohort study included 241 327 patients from 11 US health systems, 2005 through 2010. Assessments included antihyperglycemic initiation within 6 months of diabetes identification, first medication initiated, and initiation predictors.
  
  
  RESULTS
  Only 40.3% (n = 97 350) started any antihyperglycemic; 75.2% (n = 73 221) started metformin. Glycosylated hemoglobin (HbA1c) predicted initiating any antihyperglycemic (HbA1c >9%, relative risk [RR] = 3.94, 95% CI = 3.82, 4.07, vs HbA1c >6.5%-7%). Age modified the HbA1c effect: at higher HbA1c, likelihood of starting antihyperglycemics differed little across ages; at lower HbA1c, older patients were less likely to start antihyperglycemics (P < .001). Individuals with elevated serum creatinine (SCr) were more likely to started on sulfonylurea (SCr = 1.4-2, RR = 2.21 [2.05, 2.39]; SCr >2, RR = 2.75 [2.30, 3.29] vs normal SCr), particularly as HbA1c increased: patients with HbA1c 8%-9% and SCr >2 were 5.59 times (2.94, 10.65) more likely to start sulfonylurea versus those with HbA1c >6.5%-7% and normal SCr. Age predicted sulfonylurea initiation (20-39 years, RR = 0.87 [0.79, 0.95]; ≥ 80 years, RR = 2.41 [2.20, 2.65] vs 50-59 years).
  
  
  CONCLUSIONS
  Among adults with incident diabetes, metformin was generally the first antihyperglycemic initiated. However, 59.7% did not start any antihyperglycemic at diabetes identification. HbA1c and age predict antihyperglycemic initiation; SCr and age predict sulfonylurea initiation.
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.forename: Glenn K
authors.initials: GK
authors.lastname: Goodrich
authors.forename: Emily B
authors.initials: EB
authors.lastname: Schroeder
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston Lafata
authors.forename: Melissa
authors.initials: M
authors.lastname: Butler
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: adult; antihyperglycemic medication; incident diabetes; metformin; newly identified diabetes; sulfonylurea