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Progression to insulin for patients with diabetes mellitus using the Texas Medicaid database.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rascati, Karen L. Richards, Kristin M. Lopez, Debra Cheng, Lung-I Wilson, James P.
Spatial Coverage	United States Texas
Description	Country affiliation: United States Author Affiliation: Rascati KL ( The University of Texas at Austin College of Pharmacy, Austin, Texas 78712-0127, USA. krascati@mail.utexas.edu)
Abstract	BACKGROUND: Patients newly diagnosed with type 2 diabetes mellitus generally initiate therapy with either metformin [Met] or a sulfonylurea [SU] drug, followed by the addition of a second agent (Met, an SU drug, or a thiazolidinedione [TZD] drug) if the diabetes is not well controlled. If necessary, the usual third line of treatment is the addition of insulin. OBJECTIVE: The purpose of our study was to compare the progression to insulin among 3 cohorts receiving the oral antidiabetic (OAD) drug combinations Met/SU, Met/TZD, or SU/TZD. METHODS: This study used data from the Texas Medicaid database. The date of addition of a second OAD was considered a patient's index date and patients were followed for up to 5 years. Cox proportional hazards regression compared the progression to first insulin use among cohorts, using the Met/SU cohort as the reference group, while adjusting for demographics, comorbidities, and propensity scores. RESULTS: A total of 4083 patients were included in the study (Met/SU = 2872, Met/TZD = 438, and SU/TZD = 773). Insulin was added to the medication regimen of patients by the end of follow-up in 19.7% of the Met/SU cohort, 17.6% of the Met/TZD cohort, and 26.3% of the SU/TZD cohort. The adjusted Cox proportional model estimated that patients in the SU/TZD cohort had a 40% higher probability of progression to insulin than patients in the Met/SU cohort (odds ratio [OR] = 1.40; 95% CI, 1.19-1.64), whereas there was no significant difference between the Met/TZD and Met/SU cohorts (OR = 0.85; 95% CI, 0.67-1.08). CONCLUSIONS: It appears that mechanism of action may play a role in progression to insulin for concomitant OAD agents. A slower progression to insulin was seen for patients receiving a paired sensitizer regimen (ie, Met/TZD) compared with those receiving a secretagogue sensitizer regimen (ie, SU/TZD).
File Format	HTM / HTML
ISSN	01492918
Issue Number	12
Volume Number	33
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2011-12-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Diabetes Mellitus, Type 2 Drug Therapy Hypoglycemic Agents Therapeutic Use Insulin Medicaid Metformin Sulfonylurea Compounds Thiazolidinediones Aged Aged, 80 And Over Databases As Topic Disease Progression Drug Therapy, Combination Female Humans Male Middle Aged Odds Ratio Propensity Score Proportional Hazards Models Retrospective Studies Texas Time Factors Treatment Outcome United States Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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Progression to insulin for patients with diabetes mellitus using the Texas Medicaid database.