scholarly journals Monitoring Utilization Trends of Glucose-Lowering Drugs for Type 2 Diabetes in Older Adults by Frailty Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 210-210
Author(s):  
Dae Kim ◽  
Alexander Kutz ◽  
Elisabetta Patorno ◽  
Chandrasekar Gopalakrishnan
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Lowering Drug ◽  
Service Data ◽  
Over Time

Abstract Using Medicare fee-for-service data from 2013-17, we identified a cohort of patients with type 2 diabetes (T2D) who initiated a glucose-lowering drug (mean [SD] age, 74.8 (6.9) years). Amongst frail patients (CFI≥0.20), metformin use remained stable from 29.1% to 29.4%, whereas sulfonylureas (25.8% to 22.1%) and insulin (21.2% to 19.0%) use declined. Amongst non-frail patients (CFI <0.20), metformin (35.3% to 33.1%) and sulfonylurea (26.2% to 22.2%) use decreased whereas insulin (11.7% to 10.6%) use remained stable. DPP-4i and glitazones use remained stable whereas the use of newer agents such as SGLT-2i and GLP-1 RA increased steadily over the study period in both frail and non-frail patients, though their use remains low ( <8%). In conclusion, sulfonylureas and insulin accounted for about one-third of initiated glucose-lowering medications and were more frequently used by frail patients, though their use declined steadily over time with the availability of newer agents.

scholarly journals UTILIZATION TRENDS OF NEWLY APPROVED GLUCOSE-LOWERING DRUGS FOR TYPE 2 DIABETES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S581-S581
Author(s):  
Chintan Dave ◽  
Dae Kim ◽  
Elisabetta Patorno
Keyword(s):  
Type 2 Diabetes ◽  
Standard Deviation ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Medicare Population ◽  
Prior Use ◽  
Lowering Drug ◽  
Service Data

Abstract Using Medicare fee-for-service data from 2013-2015, we identified 3.2 million patients per year (mean [SD] age, 74.7 years [standard deviation, 7.2]) who were treated with glucose-lowering drugs for type 2 diabetes. Between 2013 and 2015, the proportion of patients treated with sulfonylureas declined from 27.4% to 25.1%; those using DPP4is (11.5% to 12.0%) and GLP1-RAs (1.8% to 2.4%) remained unchanged; those using SGLT2is increased from 0.2% to 1.9%. In the subgroup of patients initiating a glucose-lowering drug without prior use of the same class agent, the proportion of patients starting sulfonylureas (18.7% to 17.2% of initiators), DPP4is (16.0% to 15.0% of initiators), and GLP1-RAs (3.4% to 4.2% of initiators) changed little between 2013 and 2015, while those starting SGLT2is increased from 0.7% to 6.5% of initiators. In the Medicare population, we observed a persistently high use of sulfonylureas and a rapid uptake of SGLT2is among the newer classes.

scholarly journals Monitoring the Comparative Safety of SGLT2i vs GLP-1 RA in Older Adults With Type 2 Diabetes by Frailty Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 209-210
Author(s):  
Alexander Kutz ◽  
Chandrasekar Gopalakrishnan ◽  
Dae Kim ◽  
Elisabetta Patorno
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Propensity Score ◽  
Diabetic Ketoacidosis ◽  
Propensity Score Matching ◽  
Frailty Status ◽  
Frail Patients ◽  
Comparative Safety ◽  
Sequential Analyses

Abstract Using Medicare (4/2013-12/2017), we conducted 9 sequential analyses of patients with type 2 diabetes initiating SGLT2i vs. GLP1-RA mimicking the accrual of new data every 6 months to monitor SGLT2i safety with respect to diabetic ketoacidosis (DKA) since their U.S. approval. For each analysis, we estimated cumulative HRs (95% CIs) after 1:1 propensity score matching on >70 covariates comparing treatments within frail and non-frail patients. By analysis 1, SGLT2i were associated with a higher DKA rate vs. GLP-1RA in both frail and non-frail patients, but results were highly imprecise due to few events. With the accrual of more DKA events, precision of the estimates continued to improve through analysis 9 [HR=2.95 (95% CI, 1.19-7.31)] in frail patients; [HR=1.77 (1.15, 2.75)] in non-frail patients], with sufficiently precise estimates by analysis 6 in frail patients [HR=2.80 (95% CI, 1.03, 7.61)] and by analysis 7 in non-frail patients [HR=1.62 (95% CI, 1.01, 2.57)].

Trends in First-Line Glucose-Lowering Drug Use in Adults With Type 2 Diabetes in Light of Emerging Evidence for SGLT-2i and GLP-1RA

Diabetes Care ◽  
2021 ◽  
pp. dc202926
Author(s):  
HoJin Shin ◽  
Sebastian Schneeweiss ◽  
Robert J. Glynn ◽  
Elisabetta Patorno
Keyword(s):  
Type 2 Diabetes ◽  
Drug Use ◽  
First Line ◽  
Glucose Lowering ◽  
Lowering Drug

977-P: Trends in First-Line Glucose-Lowering Drug Use in Adults with Type 2 Diabetes in Light of Emerging Evidence for SGLT2i and GLP-1RA

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 977-P
Author(s):  
HOJIN SHIN ◽  
SEBASTIAN SCHNEEWEISS ◽  
ROBERT GLYNN ◽  
ELISABETTA PATORNO
Keyword(s):  
Type 2 Diabetes ◽  
Drug Use ◽  
First Line ◽  
Glucose Lowering ◽  
Lowering Drug

scholarly journals Increase in Number of Depression Symptoms Over Time is Related to Worse Cognitive Outcomes in Older Adults With Type 2 Diabetes

2021 ◽  
Vol 29 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Ramit Ravona-Springer ◽  
Anthony Heymann ◽  
Hung-Mo Lin ◽  
Xiaoyu Liu ◽  
Yuval Berman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cognitive Outcomes ◽  
Depression Symptoms ◽  
Over Time

scholarly journals FRAILTY AND THE EFFECTIVENESS AND SAFETY OF NEW GLUCOSE-LOWERING DRUGS IN OLDER ADULTS WITH TYPE 2 DIABETES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S581-S581
Author(s):  
Dae H Kim ◽  
Elisabetta Patorno ◽  
Medha Munshi
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Clinical Trials ◽  
Frailty Index ◽  
Emergency Department Visits ◽  
Care Providers ◽  
Glucose Lowering ◽  
Medicare Data ◽  
Dipeptidyl Peptidase 4 Inhibitors

Abstract Recently, several classes of non-insulin glucose-lowering drugs, such as dipeptidyl peptidase-4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1-RA), and sodium glucose co-transporter-2 inhibitors (SGLT2i), have been approved to treat type 2 diabetes. Clinical trials have shown that GLP1RA and SGLT2i confer cardiovascular benefit, while DPP4i do not have such benefit; these drugs do not seem to increase the risk of hypoglycemia. However, due to underrepresentation of older adults with frailty and lack of frailty assessment in clinical trials, little is known about how the effectiveness and safety of these drugs change across different levels of frailty. In this symposium, we present the real-world evidence from Medicare data April 2013-December 2016 on the utilization trends of newly approved diabetes drugs (Dr. Dave) and comparative effectiveness and safety of SGLT2i vs sulfonylurea (Dr. Pawar), SGLT2i vs DPP4i (Dr. Kim), and SGLT2i vs GLP1-RA (Dr. Patorno). The outcomes were 1) composite cardiovascular endpoint of mortality, myocardial infarction, stroke, or heart failure; and 2) severe hypoglycemia, defined as emergency department visits or hospitalizations due to hypoglycemia. We applied a validated claims-based frailty index (CFI) to estimate the treatment effectiveness and safety in non-frail (CFI<0.10), pre-frail (CFI 0.10-0.19), or frail individuals (CFI≥0.20). Following individual presentations, Dr. Munshi and presenters will lead an interactive discussion about clinical implications and methodological challenges in conducting geriatric pharmacoepidemiologic studies using Medicare data. This symposium will demonstrate the utility of CFI in claims-based pharmacoepidemiologic studies and provide health care providers with new evidence to tailor diabetes pharmacotherapy based on frailty.

343-OR: Trends in A1C and Lipid Testing, Antilipid Therapy, and Target Attainment following First-Time Glucose-Lowering Drug Treatment in Type 2 Diabetes, Denmark, 2000-2017

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 343-OR
Author(s):  
JAKOB S. KNUDSEN ◽  
DANIEL R. WITTE ◽  
ADAM HULMAN ◽  
PERNILLE F. RØNN ◽  
TORSTEN LAURITZEN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Drug Treatment ◽  
Target Attainment ◽  
Glucose Lowering ◽  
Lipid Testing ◽  
Lowering Drug ◽  
First Time

scholarly journals FRAILTY AND THE COMPARATIVE EFFECTIVENESS AND SAFETY OF SGLT2I AND GLP1-RA IN OLDER ADULTS WITH TYPE 2 DIABETES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S582-S582
Author(s):  
Elisabetta Patorno ◽  
Ajinkya Pawar ◽  
Seoyoung Kim ◽  
Dae Kim
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Comparative Effectiveness ◽  
Retrospective Cohort ◽  
Severe Hypoglycemia ◽  
Medicare Data ◽  
Frail Patients ◽  
Cardiovascular Endpoint

Abstract We conducted a 1:1 propensity score-matched retrospective cohort study of 87,218 patients with type 2 diabetes (mean age, 71.5 years [standard deviation, 5.1]) initiating a SGLT2i or a GLP1-RA in Medicare data. We estimated HRs (95% CIs) for a composite cardiovascular endpoint and severe hypoglycemia comparing the two treatments in the entire population and by the CFI-based frailty subgroups. Compared with GLP1-RA, SGLT2i were associated with similar rates of the composite cardiovascular endpoint (HR, 0.94 [95% CI, 0.86-1.03]) and severe hypoglycemia (0.87 [0.71-1.07]) over a mean follow-up of 8.6 months. The rate of composite cardiovascular endpoint was not meaningfully different between SGLT2i and GLP1-RA across non-frail (1.33 [0.80-2.23]), pre-frail (0.96 [0.85-1.08]), and frail patients (0.87 [0.73-1.04]). Similarly, the rate of severe hypoglycemia was not meaningfully different between the two treatments among non-frail (0.97 [0.20-4.80]), pre-frail (0.83 [0.64-1.08]), and frail patients (0.95 [0.67-1.34]).

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