Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec;21(12):702-712.
doi: 10.1089/dia.2019.0213. Epub 2019 Oct 9.

Adoption of New Glucose-Lowering Medications in the U.S.-The Case of SGLT2 Inhibitors: Nationwide Cohort Study

Rozalina G McCoy  1   2   3 , Hayley J Dykhoff  2   3 , Lindsey Sangaralingham  2   3 , Joseph S Ross  4   5   6   7 , Pinar Karaca-Mandic  8   9 , Victor M Montori  10   11 , Nilay D Shah  2   3   12
Affiliations

Adoption of New Glucose-Lowering Medications in the U.S.-The Case of SGLT2 Inhibitors: Nationwide Cohort Study

Rozalina G McCoy et al. Diabetes Technol Ther. 2019 Dec.

Abstract

Background: High-quality diabetes care is evidence-based, timely, and equitable. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are the most recently approved class of glucose-lowering medications with additional cardio- and renal-protective benefits and low risk of hypoglycemia. Cardiovascular and kidney disease are among the most common chronic diabetes complications, whereas hypoglycemia is the most prevalent adverse effect of glucose-lowering therapy. We examine the sociodemographic and clinical factors associated with early SGLT2i initiation and appropriateness of use based on contemporaneous scientific evidence. Materials and Methods: Retrospective analysis of medical and pharmacy claims data from OptumLabs® Data Warehouse for commercially insured and Medicare Advantage adult beneficiaries with diabetes types 1 and 2, who filled any glucose-lowering medication between January 1, 2013 and December 31, 2016. Demographic (age, sex, race, income), clinical (comorbidities), and insurance-related factors affecting first prescription for a SGLT2i were examined using multivariable logistic regression. Results: Among 1,054,727 adults with pharmacologically treated diabetes, 7.2% (n = 75,500) initiated a SGLT2i. Patients with prior myocardial infarction (MI) (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.91-0.96), heart failure (HF) (OR: 0.93, 95% CI: 0.91-0.94), kidney disease (OR: 0.80, 95% CI: 0.78-0.81), and severe hypoglycemia (OR: 0.96, 95% CI: 0.94-0.98) were all less likely to start a SGLT2i; P < 0.001 for all. SGLT2i were also less likely to be started by patients ≥75 years (OR: 0.57, 95% CI: 0.55-0.59, vs. 18-44 years), Black patients (OR: 0.93, 95% CI: 0.91-0.95, vs. White), and those with Medicare Advantage insurance (OR: 0.63, 95% CI: 0.62-0.64, vs. commercial). Conclusions: Younger, healthier, non-Black patients with commercial health insurance were most likely to start taking SGLT2i. Patients with MI, HF, kidney disease, and prior hypoglycemia were less likely to use SGLT2i, despite evidence supporting their preferential use in these patients. Efforts to address this treatment-risk paradox may help improve health outcomes among patients with type 2 diabetes.

Keywords: Administrative claims data; Diabetes mellitus; Evidence-based medicine; Health services research; Pharmacoepidemiology; SGLT2 inhibitor.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
Trends in SGLT2i initiation. Rates of SGLT2i initiation per 100,000 adults with pharmacologically treated diabetes are shown by drug (A), health insurance coverage (B), diabetes type (C), and prescriber specialty (D). SGLT2, sodium-glucose cotransporter-2.
<b>FIG. 2.</b>
FIG. 2.
Predictors of SGLT2i initiation. Multivariable logistic regression analysis of the odds of SGLT2i initiation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. CDC. Centers for Disease Control and Prevention: National Diabetes Statistics Report, 2017. Centers for Disease Control and Prevention US Department of Health and Human Services, updated February 24, 2018. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html (accessed July5, 2019)
    1. ADA. American Diabetes Association: Section 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2019. Diabetes Care 2019;42:S34–S45 - PubMed
    1. Zinman B, Wanner C, Lachin JM, et al. : Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117–2128 - PubMed
    1. Wanner C, Inzucchi SE, Lachin JM, et al. : Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016;375:323–334 - PubMed
    1. Neal B, Perkovic V, Mahaffey KW, et al. : Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:644–657 - PubMed

Publication types

  NODES
admin 1
Association 1
COMMUNITY 2
INTERN 8
twitter 2