title: Treatment discontinuation of oral hypoglycemic agents and healthcare utilization among patients with diabetes.
abstract: To investigate the discontinuation of oral antihyperglycemic agents (OHA), and examine factors associated with OHA discontinuation, and the effect of OHA discontinuation on glycemic control and healthcare utilization among diabetes patients prescribed dual OHA therapy.
  
  
  
  We identified 23,612 adult patients aged >18years with a diagnosis of type 2 diabetes who initiated dual OHA therapy between 1/1/2005 and 6/30/2010. The date of initiation of the second OHA was defined as the index date. Discontinuation was defined as a gap >1.5 times the last days' supply without subsequent reinitiation.
  
  
  
  Over 24months, 16.9% discontinued 1 OHA and 9.2% discontinued both. Patients who discontinued were more likely to be female, younger, Black or of Hispanic ethnicity, have more comorbidities, higher medication co-pays, start both OHAs together, have higher healthcare utilization before the index date and less likely to use prescription mail order compared with patients who did not discontinue. In multivariable regression models, patients who discontinued were more likely to be hospitalized or have emergency department visits during follow-up.
  
  
  
  Discontinuation of OHAs is common among patients with diabetes and is associated with several patient factors and increased healthcare utilization. Future research should further examine reasons for OHA discontinuation.
authors: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA. Electronic address: Kristi.Reynolds@kp.org.
authors: Kristi
authors: K
authors: Reynolds
authors: Western University of Health Sciences, Department of Pharmacy Practice & Administration, Pomona, CA, USA.
authors: JaeJin
authors: J
authors: An
authors: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.
authors: Jun
authors: J
authors: Wu
authors: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.
authors: Teresa N
authors: TN
authors: Harrison
authors: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.
authors: Rong
authors: R
authors: Wei
authors: University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research, Baltimore, MD, USA.
authors: Bruce
authors: B
authors: Stuart
authors: Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, CA, USA.
authors: John P
authors: JP
authors: Martin
authors: Merck & Co., Inc., Kenilworth, NJ, USA.
authors: Catherine S
authors: CS
authors: Wlodarczyk
authors: Merck & Co., Inc., Kenilworth, NJ, USA.
authors: Swapnil N
authors: SN
authors: Rajpathak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents
keywords: Medication adherence; Oral antihyperglycemics; Oral hypoglycemic agents; Treatment adherence/compliance; Type 2 diabetes