title: Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study.
abstract: OBJECTIVE
  The goal of this study was to describe medication usage patterns in patients with type 2 diabetes mellitus (T2DM) initiating treatment with non-insulin antidiabetic drugs (NIADs), basal insulin, or prandial/mixed insulin using real-world data.
  
  
  METHODS
  A retrospective analysis using the Truven Health MarketScan Research Databases was conducted to identify adults (≥18 years) with T2DM from 2006 to 2012. Patients were categorized into four cohorts based on diabetes treatment. Cohort 1 (n=597 664) consisted of newly diagnosed patients who did not receive any treatment, cohort 2 (n=342 511) included NIAD initiators, cohort 3 (n=99 578) included basal insulin initiators, and cohort 4 (n=62 876) included prandial/mixed insulin initiators. Patients transitioned out of a cohort once they met the criteria for the next one.
  
  
  RESULTS
  Patients in cohort 2 were younger (56.2 years, SD±12.1) than patients in cohorts 1, 3, and 4 (58 years, SD±0.75). Metformin was the most commonly prescribed drug in cohort 2 patients. Basal insulin usage decreased from 71% in year 1 to 47% in year 4, in cohort 3 patients. Approximately one-third of these patients switched to prandial/mixed insulin each year. In cohort 4, the usage of prandial/mixed insulin decreased to 61% by year 4. Use of basal insulin and NIAD remained common in this group. Mean glycosylated hemoglobin (HbA1c) values decreased by ∼1% for each of the treatment cohorts following treatment initiation and remained stable during follow-up. All-cause and diabetes-related medical costs were highest for patients in cohorts 3 and 4.
  
  
  CONCLUSIONS
  Overall, our findings demonstrate that treatment intensification was low in all study cohorts despite elevated HbA1c levels during preindex and follow-up period.
authors.affiliation: Truven Health Analytics , Cambridge, Massachusetts , USA.
authors.forename: Machaon
authors.initials: M
authors.lastname: Bonafede
authors.affiliation: Health Economics and Outcomes Research , Becton Dickinson , Franklin Lakes, New Jersey , USA.
authors.forename: Arthi
authors.initials: A
authors.lastname: Chandran
authors.affiliation: Health Economics and Outcomes Research , Becton Dickinson , Franklin Lakes, New Jersey , USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: DiMario
authors.affiliation: Medical Affairs , Becton Dickinson , Franklin Lakes, New Jersey , USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Saltiel-Berzin
authors.affiliation: Medical Affairs , Becton Dickinson , Franklin Lakes, New Jersey , USA.
authors.forename: Drilon
authors.initials: D
authors.lastname: Saliu
keywords: Adherence to Medications; Glycemic Control; Type 2 Diabetes