scholarly journals Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States

2021 ◽  
Author(s):  
Veer Sangha ◽  
Kasia Lipska ◽  
Zhenqiu Lin ◽  
Silvio E. Inzucchi ◽  
Darren K. McGuire ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
The United States ◽  
Cardiovascular Death ◽  
Cross Sectional Study ◽  
Atherosclerotic Cardiovascular Disease ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors

Background: Evidence from large randomized clinical trials supports the benefit of sodium-glucose cotransporter-2 inhibitors (SGLT2i) to improve cardiovascular and kidney outcomes in patients with type 2 diabetes mellitus (T2DM) with or at high risk for atherosclerotic cardiovascular disease or chronic kidney disease. Considering this evidence, which has been expanding since the product label indication for empagliflozin to reduce risk of cardiovascular death in 2016, clinician-level variation in the prescription of SGLT2i among US Medicare beneficiaries was evaluated. Methods: Antihyperglycemic medication prescribers were identified as those physicians and advanced practice providers prescribing metformin in Medicare part D prescriber data. In this cross-sectional study, the proportion prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. SGLT2i use was compared with other second-line antihyperglycemic medication classes, sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP4is). Results: Among 232,523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018 (diabetes-treating clinicians), 45,255 (19.5%) prescribed SGLT2i. There was substantial variation across specialties - from 72% of endocrinologists to 14% of cardiologists who prescribed metformin also prescribed SGLT2i. Between 2014 and 2018, the number prescribing SGLT2i increased 5 fold from 9,048 in 2014 to 45,255 in 2018. Among clinicians who prescribed both sulfonylureas and SGLT2i in 2018, SGLT2i was prescribed to a median 33 beneficiaries for every 100 prescribed sulfonylureas (IQR 18, 67). SGLT2i use relative to sulfonylureas increased from 19 (IQR 11, 34) per 100 in 2014 to 33 (IQR 18, 67) per 100 in 2018 (P-trend <0.001). Conclusions: Eighty percent of clinicians prescribing metformin to Medicare beneficiaries did not prescribe SGLT2i in 2018. Moreover, sulfonylureas prescriptions were 3 times more frequent than those of SGLT2is, although a pattern of increasing uptake may portend future trends. These findings highlight a baseline opportunity to improve care and outcomes for patients with T2DM.

scholarly journals Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

2020 ◽  
pp. bjgp20X714089
Author(s):  
Michelle Greiver ◽  
Alys Havard ◽  
Juliana Bowles ◽  
Sumeet Kalia ◽  
Chen Tao ◽  
...  
Keyword(s):  
New Drugs ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Cross Sectional Analysis ◽  
Drug Classes ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Lowering Drug ◽  
Sectional Analysis

Abstract Background: Several new classes of glucose lowering medications have been introduced in the past two decades. Some, such as Sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as Dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake, in order to find ways to support the use of more effective medications. Aims: We studied the uptake of these new classes amongst patients with type 2 diabetes. Design and setting: Retrospective repeated cross-sectional analysis. We compared rates of medication uptake in Australia, Canada, England and Scotland. Method: We used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose-lowering drug class in each year of interest, excluding those on insulin only. We determined proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes. Results: By 2017, data from 238,609 patients were included. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017 more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). Conclusions: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.

scholarly journals Trends in diabetes medications in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Sumeet Kalia
Keyword(s):  
Medical Data ◽  
New Drugs ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Sectional Analysis ◽  
Dispensing Data

BackgroundWe studied the uptake of new classes of glucose lowering medications, such as Dipeptidyl peptidase-4 inhibitors (DPP4s) and Sodium-glucose cotransporter 2 inhibitors (SGLT2s) amongst patients living with type 2 diabetes. We compared this in Australia, Canada, England and Scotland, and explored whether these new drugs are supplementing or replacing older classes of medications. Research Design and MethodsWe used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose lowering medication in each year of interest; we excluded those on insulin only. We determined proportions of patients in each nation on each class of medication, as well as on combinations of classes. ResultsIn 2017, data from 28,063 patients in Canada, 106,000 in Australia, 88,953 in England and 15,603 in Scotland were included. The proportion of patients on metformin increased by 3.4% in Australia (95% CI: 3.24% to 3.55%) and decreased in the other nations. Canada had the greatest decrease, at 4.7% (95% CI: -5.05% to -4.34%). Sulfonylurea use decreased in most nations, while DPP4s increased in all. By 2017, between 10.1% and 15.3% of patients were on a SGLT2 and the use of either a DPP4 or SGLT2 combined with metformin approached or exceeded the use of sulfonylureas with metformin. ConclusionsNewer, more expensive medications are replacing sulfonylureas and, to a lesser degree, metformin. The effects of these trends on health outcomes and overall costs should be examined.

scholarly journals Differences in Characteristics of Medicare Patients Treated by Ophthalmologists and Optometrists

2020 ◽  
Author(s):  
Darby D. Miller ◽  
Michael W. Stewart ◽  
Joshua J. Gagne ◽  
Alan L. Wagner ◽  
Aaron Y. Lee
Keyword(s):  
United States ◽  
Rhode Island ◽  
The United States ◽  
Cross Sectional Study ◽  
Medicare Beneficiaries ◽  
Racially Diverse ◽  
Cross Sectional ◽  
Clinical Complexity ◽  
Utilization Data ◽  
Diverse Groups

AbstractPurposeTo quantify differences in the age, gender, race, and clinical complexity of Medicare beneficiaries treated by ophthalmologists and optometrists in each of the United States.DesignCross-sectional study based on publicly accessible Medicare payment and utilization data from 2012 to 2017.MethodsFor each ophthalmic and optometric provider, demographic information of treated Medicare beneficiaries was obtained from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services (CMS) for the years 2012 to 2017. Clinical complexity was defined using Hierarchical Condition Category (HCC) coding.ResultsFrom 2012 to 2017, ophthalmologists in every state treated significantly older beneficiaries, with the greatest difference (4.99 years in 2014) between provider groups seen in Rhode Island. In most states, there was no gender difference among patients treated by the providers, but in 46 states ophthalmologists saw significantly more racially diverse groups of beneficiaries. HCC risk score analysis demonstrated that ophthalmologists in all 50 states saw more medically complex beneficiaries and the differences were statistically significant in 47 states throughout all six years.ConclusionsAlthough there are regional variations in the characteristics of patients treated by ophthalmologists and optometrists, ophthalmologists throughout the United States manage older, more racially diverse, and more medically complex Medicare beneficiaries.

scholarly journals Trends of use of SGLT2 inhibitors in Qatar

2021 ◽  
Author(s):  
Nancy Zaghloul ◽  
Ahmed Awaisu ◽  
Ahmed Mahfouz ◽  
Sumaya Al Saadi ◽  
Hazem Elewa
Keyword(s):  
Cross Sectional Study ◽  
Slight Reduction ◽  
Mena Region ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Glucosidase Inhibitors ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Progression Of Renal Disease

Background: Type 2 diabetes mellitus (T2DM) represents a growing health challenge in Qatar and worldwide. T2DM is associated with a high risk of cardiovascular (CV) morbidity and mortality, and progression of renal disease. Sodium glucose co-transporter 2 inhibitors (SGLT2is) are the most recently approved class of glucose lowering medications (GLMs). To date, there is a limited knowledge about the adoption of SGLT2is by clinicians compared to other oral GLMs in Qatar and Middle East and North Africa (MENA) region. Accordingly, this proposed study aims to explore the trends in SGLT2is use compared to other oral GLMs in Qatar from 2016 to 2020. Methods: This is a descriptive, retrospective cross-sectional study where information on all oral GLMs prescriptions dispensed as in- or out-patient from 2016 to 2020 in all Hamad Medical Corporation (HMC) hospitals were collected. Outcomes included the number and relative frequency of quarterly prescriptions of different oral GLMs classes [metformin, sulfonylureas (SUs), dipeptidyl peptidase 4 inhibitors (DPP-4is), thiazolidinediones (TZDs), meglitinides (MEGs), α-glucosidase inhibitors (AGIs), and SGLT2is] from 2016 to 2020. Results: Overall, the prescription rate of GLMs increased during the last five years. SGLT2is use increased over the years after being introduced to the formulary in 2017, replacing SUs which exhibited significant decline between 2017 and 2020. There was a slight reduction in metformin use, and a slight increase in DPP-4is use. TZDs, MEGs, and AGIs prescriptions remained stable. Among SGLT2is, empagliflozin showed considerable increase on the expense of dapagliflozin which decreased significantly by the end of 2018. Conclusion: SGLT2is have been gradually replacing SUs in Qatar and the trend of their use is similar to that reported in other countries. The trend among SGLT2is suggests greater preference for empagliflozin over dapagliflozin.

Geographic Variation in Epistaxis Interventions Among Medicare Beneficiaries

2020 ◽  
Vol 129 (9) ◽  
pp. 878-885
Author(s):  
Kevin Hur ◽  
Ido Badash ◽  
Guy Talmor ◽  
Elisabeth H Ference ◽  
Bozena B Wrobel
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
The United States ◽  
Cross Sectional Study ◽  
Medicare Beneficiaries ◽  
Geographic Variability ◽  
Provider Type ◽  
Cross Sectional ◽  
Medicare Population ◽  
Medicare Patients

Objectives: To quantify the utilization of epistaxis procedures in the elderly population and assess whether the geographic variability of these procedures is associated with hypertension and direct oral anticoagulant (DOAC) use. Methods: A cross-sectional study was performed on publicly available Medicare procedure and beneficiary data from 2013 to 2016 for all epistaxis procedures categorized by Common Procedural Terminology (CPT). Epistaxis procedures were analyzed by state, complexity, and provider type. Pearson’s correlation coefficient was calculated. Results: Over 4 years, 2 19 827 epistaxis procedures were performed on Medicare patients, 44.3% of which were categorized as simple (control of nasal hemorrhage: anterior simple or posterior primary). Otolaryngologists performed 92.6% of all epistaxis procedures. The frequency of epistaxis procedures performed by state ranged from 0.99 procedures per 10 000 Medicare beneficiaries (PP10K) in Hawaii to 25.7 PP10K in New Jersey. The percentage of epistaxis interventions categorized as complex (anterior complex, posterior subsequent, with nasal endoscopy, or open procedures) in each state varied from 0% in North Dakota to 72.6% in Hawaii. Epistaxis procedure utilization was weakly correlated with the prevalence of hypertension ( R2 = 0.08, P = .04) and higher percentage of DOAC among all anticoagulants prescribed ( R2 = 0.08, P = .04) in a state’s Medicare population. Utilization of complex epistaxis interventions was not correlated with the prevalence of hypertension or DOAC use. Conclusions: Otolaryngologists perform the vast majority of epistaxis procedures in the Medicare population. However, practice patterns vary across the United States. Hypertension and DOAC use are weakly associated with the utilization of epistaxis interventions.

scholarly journals Pharmacogenetics of new classes of antidiabetic drugs

2021 ◽  
Author(s):  
Selma Imamovic Kadric ◽  
Aida Kulo Cesic ◽  
Tanja Dujic
Keyword(s):  
Drug Targets ◽  
Antidiabetic Drugs ◽  
Atherosclerotic Cardiovascular Disease ◽  
Protective Effects ◽  
Metabolizing Enzymes ◽  
Dipeptidyl Peptidase 4 ◽  
Drug Classes ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucagon Like Peptide 1

Type 2 diabetes (T2D) has a continuously rising prevalence worldwide. Pharmacogenetics has been recognized as a promising concept for pharmacological treatment of T2D, as antidiabetic drugs are not equally effective and safe for all patients, and the costs of diabetes treatment are increasing. The latest published guidelines on T2D treatment firmly endorse the use of newer antidiabetic drugs, sodium-glucose cotransporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-IVi), and glucagon-like peptide-1 receptor agonists (GLP-1RA), considering their satisfactory pharmacological effect and good safety profile. Furthermore, SGLT2i and GLP-1RA show protective effects in patients with established atherosclerotic cardiovascular disease and chronic kidney disease. However, there has been growing evidence that the effectiveness and safety of these drug classes could depend on genetic variability. Here we summarized the results of the published studies on the pharmacogenetic biomarkers for the three drug classes. A number of genetic variations have been investigated so far. The explored candidate genes mostly encode drug targets, drug-metabolizing enzymes, and genes linked to T2D risk. Although many of the results are promising, it is still necessary to obtain more information from larger controlled studies to confirm their clinical significance. This approach may lead towards more personalized treatment for patients with T2D.

Does a Graduate Course in Fluency Disorders Make a Difference?

2010 ◽  
Vol 20 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Evelyn R. Klein ◽  
Barbara J. Amster
Keyword(s):  
Undergraduate Students ◽  
Graduate Programs ◽  
The United States ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Graduate Course ◽  
Cross Sectional ◽  
Fluency Disorders ◽  
Introductory Course ◽  
Communicative Disorders

Abstract A study by Yaruss and Quesal (2002), based on responses from 134 of 239 ASHA accredited graduate programs, indicated that approximately 25% of graduate programs in the United States allow students to earn their degree without having coursework in fluency disorders and 66% of programs allow students to graduate without clinical experience treating people who stutter (PWS). It is not surprising that many clinicians report discomfort in treating PWS. This cross-sectional study compares differences in beliefs about the cause of stuttering between freshman undergraduate students enrolled in an introductory course in communicative disorders and graduate students enrolled and in the final weeks of a graduate course in fluency disorders.

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