scholarly journals Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

2021 ◽  
Author(s):  
Hui Shao ◽  
Michael Laxy ◽  
Stephen R. Benoit ◽  
Yiling J. Cheng ◽  
Edward W. Gregg ◽  
...  
Keyword(s):  
Decomposition Analysis ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Drug Classes ◽  
Out Of Pocket Payments ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Main Driver ◽  
Glucagon Like Peptide 1 ◽  
Total Payment

<b><i>Objective </i></b> <p>To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.</p> <p><b><i>Methods</i></b></p> <p>We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. </p> <p><b><i>Results</i></b></p> <p>Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.<b><i> </i></b></p> <p><b><i>Conclusion</i></b></p> <p>Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver. </p>

scholarly journals Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

2021 ◽  
Author(s):  
Hui Shao ◽  
Michael Laxy ◽  
Stephen R. Benoit ◽  
Yiling J. Cheng ◽  
Edward W. Gregg ◽  
...  
Keyword(s):  
Decomposition Analysis ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Drug Classes ◽  
Out Of Pocket Payments ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Main Driver ◽  
Glucagon Like Peptide 1 ◽  
Total Payment

<b><i>Objective </i></b> <p>To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.</p> <p><b><i>Methods</i></b></p> <p>We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. </p> <p><b><i>Results</i></b></p> <p>Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.<b><i> </i></b></p> <p><b><i>Conclusion</i></b></p> <p>Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver. </p>

scholarly journals Glucose-Lowering Medications and Post-Dementia Survival in Patients with Diabetes and Dementia

2022 ◽  
pp. 1-13
Author(s):  
Juraj Secnik ◽  
Hong Xu ◽  
Emilia Schwertner ◽  
Niklas Hammar ◽  
Michael Alvarsson ◽  
...  
Keyword(s):  
Survival Models ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Intention To Treat ◽  
Dementia Patients ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide 1 ◽  
Using Data

Background: The effectiveness of glucose-lowering drugs (GLDs) is unknown among patients with dementia. Objective: To analyze all-cause mortality among users of six GLDs in dementia and dementia-free subjects, respectively. Methods: This was a longitudinal open-cohort registry-based study using data from the Swedish Dementia Registry, Total Population Register, and four supplemental registers providing data on dementia status, drug usage, confounders, and mortality. The cohort comprised 132,402 subjects with diabetes at baseline, of which 11,401 (8.6%) had dementia and 121,001 (91.4%) were dementia-free. Subsequently, comparable dementia – dementia-free pairs were sampled. Then, as-treated and intention-to-treat exposures to metformin, insulin, sulfonylurea, dipeptidyl-peptidase-4 inhibitors, glucagon-like peptide-1 analogues (GLP-1a), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) were analyzed in the parallel dementia and dementia-free cohorts. Confounding was addressed using inverse-probability weighting and propensity-score matching, and flexible parametric survival models were used to produce hazard ratios (HR) and 95% confidence intervals (CI) of the association between GLDs and all-cause mortality. Results: In the as-treated models, increased mortality was observed among insulin users with dementia (HR 1.34 [95%CI 1.24–1.45]) as well as in dementia-free subjects (1.54 [1.10–1.55]). Conversely, sulfonylurea was associated with higher mortality only in dementia subjects (1.19 [1.01–1.42]). GLP-1a (0.44 [0.25–0.78]) and SGLT-2i users with dementia (0.43 [0.23–0.80]) experienced lower mortality compared to non-users. Conclusion: Insulin and sulfonylurea carried higher mortality risk among dementia patients, while GLP-1a and SGLT-2i were associated with lower risk. GLD-associated mortality varied between dementia and comparable dementia-free subjects. Further studies are needed to optimize GLD use in dementia patients.

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 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.

scholarly journals The Role of the α Cell in the Pathogenesis of Diabetes: A World beyond the Mirror

2021 ◽  
Vol 22 (17) ◽  
pp. 9504
Author(s):  
María Sofía Martínez ◽  
Alexander Manzano ◽  
Luis Carlos Olivar ◽  
Manuel Nava ◽  
Juan Salazar ◽  
...  
Keyword(s):  
Cell Function ◽  
Cell Mass ◽  
Glucagon Secretion ◽  
Endocrine Regulation ◽  
Β Cell ◽  
Cell Hyperplasia ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucagon Like Peptide 1 ◽  
Chronic Hyperglycaemia

Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent chronic metabolic disorders, and insulin has been placed at the epicentre of its pathophysiological basis. However, the involvement of impaired alpha (α) cell function has been recognized as playing an essential role in several diseases, since hyperglucagonemia has been evidenced in both Type 1 and T2DM. This phenomenon has been attributed to intra-islet defects, like modifications in pancreatic α cell mass or dysfunction in glucagon’s secretion. Emerging evidence has shown that chronic hyperglycaemia provokes changes in the Langerhans’ islets cytoarchitecture, including α cell hyperplasia, pancreatic beta (β) cell dedifferentiation into glucagon-positive producing cells, and loss of paracrine and endocrine regulation due to β cell mass loss. Other abnormalities like α cell insulin resistance, sensor machinery dysfunction, or paradoxical ATP-sensitive potassium channels (KATP) opening have also been linked to glucagon hypersecretion. Recent clinical trials in phases 1 or 2 have shown new molecules with glucagon-antagonist properties with considerable effectiveness and acceptable safety profiles. Glucagon-like peptide-1 (GLP-1) agonists and Dipeptidyl Peptidase-4 inhibitors (DPP-4 inhibitors) have been shown to decrease glucagon secretion in T2DM, and their possible therapeutic role in T1DM means they are attractive as an insulin-adjuvant therapy.

scholarly journals Association Between Diabetes Medications and the Risk of Parkinson's Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaocui Qin ◽  
Xia Zhang ◽  
Pinyu Li ◽  
Min Wang ◽  
Li Yan ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Meta Analysis ◽  
Limited Data ◽  
Dipeptidyl Peptidase 4 ◽  
Single Study ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucagon Like Peptide 1

Background: Diabetes mellitus (DM) increases the risk of Parkinson's disease (PD). However, whether DM medications play a part on that increased PD risk is unclear. We designed this meta-analysis to assess the influence of different oral DM medications on the PD risk in patients with DM.Methods: We searched PubMed, Embase, and CENTRAL databases for relevant studies up until January 2021. We pooled adjusted outcomes to assess the PD risk in patients using different DM medications including sulfonylurea, metformin, glitazones (GTZ), dipeptidyl peptidase-4 inhibitors (DPP4i), and glucagon-like peptide-1 agonists (GLP1a).Results: We included 10 studies in our analysis. Our results indicate a lack of significant association between the PD risk and the use of sulfonylureas (three studies; HR, 1.26; 95% CI, 0.95 to 1.66; I2, 70%; p = 0.11), DPP4i (three studies; HR, 0.69; 95% CI, 0.35 to 1.38; I2, 88%; p = 0.30), metformin (five studies; HR, 1.23; 95% CI, 0.98 to 1.78; I2, 84%; p = 0.13), and GTZ (six studies; HR, 0.88; 95% CI, 0.66 to 1.16; I2, 92%; p = 0.35). After exclusion of a single study in the GTZ analysis, our results indicate a significantly reduced PD risk with GTZ use (HR, 0.78; 95% CI, 0.65 to 0.93; I2, 59%; p = 0.06). Similarly, after the exclusion of a single study, our results indicate a significantly increased PD risk with the use of metformin (HR, 1.50; 95% CI, 1.11 to 2.02; I2, 80%; p = 0.008). We also found a significantly reduced PD risk with the use of GLP1a (two studies; HR, 0.41; 95% CI, 0.19 to 0.87; I2, 0%; p = 0.02).Conclusion: The role of different DM medications on the PD risk remains unclear, and the quality of studies is low. While our analysis suggests a lack of association between the use of metformin, GTZ, DPP4i, and sulfonylureas and the PD risk, metformin (to a higher degree) and GTZ may still increase the risk. Limited data suggest a protective effect of GLP1a on the PD risk.

Sign in / Sign up

Export Citation Format

Share Document