title: Opioid use in the management of diabetic peripheral neuropathy (DPN) in a large commercially insured population.
abstract: OBJECTIVE
  To examine the proportion of diabetic peripheral neuropathy (DPN) patients receiving pharmacologic DPN treatments and specifically to identify the rates and factors associated with opioid use and first-line opioid use.
  
  
  METHODS
  A 10% sample of IMS-LifeLink claims data from 1998 through 2008 was used. The study population consisted of diabetic patients who met DPN criteria using a validated DPN algorithm. Multivariable logistic regression controlling for demographics, comorbidities, and other clinical characteristics was used to identify factors associated with any DPN pharmacologic treatment, any opioid use, and first-line opioid treatment. Sensitivity analyses were conducted to explore variations in exclusion criteria as well as opioid use definitions.
  
  
  RESULTS
  A total of 666 DPN patients met inclusion criteria and pharmacologic treatment was received by 288 patients (43.24%) and of those, 154 (53.47%) had DPN-related opioid use and 96 (33.33%) received opioid as first-line treatment. Persons with diabetic complications were more likely to use opioids (odds ratio=4.53; 95% confidence interval, 1.09-18.92). Food and Drug Administration-approved DPN agents duloxetine 1.04% (n=3) and pregabalin 5.56% (n=16) had much lower rates of use. DPN-related drug use and DPN-related opioid usage increased as we used less restrictive samples in sensitivity analyses.
  
  
  CONCLUSIONS
  Opioids were the most frequently prescribed first-line agents for DPN. More than 50% of DPN patients remained untreated with pharmacologic agents 1 year after a DPN diagnosis.
authors: *Division of Pharmaceutical Evaluation and Policy †Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Pravinkumar R
authors: PR
authors: Patil
authors: Jonathan
authors: J
authors: Wolfe
authors: Qayyim
authors: Q
authors: Said
authors: Jeremy
authors: J
authors: Thomas
authors: Bradley C
authors: BC
authors: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D005260:Female; D059033:For-Profit Insurance Plans / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid