title: Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.
abstract: To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).
  
  
  
  Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual1) age- and sex-standardized proportion of patients who filled each class of agents;2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c(HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).
  
  
  
  From 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; allP< 0.001). The proportion of patients with HbA1c<7% declined (from 56.4 to 54.2%;P< 0.001) and with HbA1c≥9% increased (9.9 to 12.2%;P< 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years;P= 0.72), declined modestly among the oldest patients (from 2.9 to 2.3;P< 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5;P= 0.36).
  
  
  
  During the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged.
authors.affiliation: Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT kasia.lipska@yale.edu.
authors.forename: Kasia J
authors.initials: KJ
authors.lastname: Lipska
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Yao
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Rozalina G
authors.initials: RG
authors.lastname: McCoy
authors.affiliation: Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.|Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco VA Health Care System, San Francisco, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.affiliation: Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Inzucchi
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.|Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|OptumLabs, Cambridge, MA.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage; D004363:Drug Utilization; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage; D045162:Thiazolidinediones / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones