Antihyperglycemic Medications: A Claims-Based Estimate of First-line Therapy Use Prior to Initialization of Second-line Medications.
Antihyperglycemic Medications: A Claims-Based Estimate of First-line Therapy Use Prior to Initialization of Second-line Medications.
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DOI：
10.2337/dc17-0213
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发表时间：
2017-11
期刊：
影响因子：
16.2
通讯作者：
Mandl KD
中科院分区：
文献类型：
--
作者：
Tseng YJ;Steinberg G;Fox KP;Armstrong J;Mandl KD
美国糖尿病协会推荐二甲双胍作为2型糖尿病的一线治疗。然而，不依从降糖药物是常见的，临床医生可能会混淆不依从与药理学失败，可能导致二线治疗的过早处方。我们测量了二甲双胍在二线治疗开始前的使用情况。这项回顾性横断面研究使用了美国健康福利公司安泰（Aetna）2010年至2015年覆盖的个人的无法识别的成员索赔数据。受益人有两个医生索赔或一个住院与2型糖尿病诊断。二甲双胍的推荐使用是通过60天内所覆盖的天数比例来衡量的。通过敏感性分析，我们对使用低成本仿制处方药计划的受益人的百分比进行了不同的估计。共有52，544名2型糖尿病患者符合条件。在接受二线治疗的22，956例患者中，只有1，875例（8.2%）在过去60天内有推荐使用二甲双胍的证据，6，441例（28.0%）没有既往服用二甲双胍的证据。在最高灵敏度范围内，只有49.5%的患者可以推荐使用。如果患者在没有推荐使用二甲双胍的证据的情况下接受了初始二线药物治疗，则更有可能接受额外的二线降糖药物或胰岛素治疗（P < 0.001）。尽管已发布指南，但二线治疗通常在没有一线治疗推荐使用证据的情况下启动。明显的治疗失败，这实际上可能是由于不遵守指南，是常见的。需要护理点和人群水平的过程来监测和改善指南的依从性。
The American Diabetes Association recommends metformin as first-line therapy for type 2 diabetes. However, nonadherence to antihyperglycemic medication is common, and a clinician could confuse nonadherence with pharmacologic failure, potentially leading to premature prescribing of second-line therapies. We measured metformin use prior to second-line therapy initialization. This retrospective cross-sectional study used unidentifiable member claims data from individuals covered from 2010 to 2015 by Aetna, a U.S. health benefits company. Beneficiaries with two physician claims or one hospitalization with a type 2 diabetes diagnosis were included. Recommended use of metformin was measured by the proportion of days covered over 60 days. Through sensitivity analysis, we varied estimates of the percentage of beneficiaries who used low-cost generic prescription medication programs. A total of 52,544 individuals with type 2 diabetes were eligible. Of 22,956 patients given second-line treatment, only 1,875 (8.2%) had evidence of recommended use of metformin in the prior 60 days, and 6,441 (28.0%) had no prior claims evidence of having taken metformin. At the top range of sensitivity, only 49.5% patients could have had recommended use. Patients were more likely to be given an additional second-line antihyperglycemic medication or insulin if they were given their initial second-line medication without evidence of recommended use of metformin (P < 0.001). Despite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common. Point-of-care and population-level processes are needed to monitor and improve guideline adherence.
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影响因子：
9.7
作者：
Brennan, Troyen A.;Dollear, Timothy J.;Grambley, William
通讯作者：
Grambley, William
影响因子：
39
作者：
Ho, P. Michael;Lambert-Kerzner, Anne;Del Giacco, Eric J.
通讯作者：
Del Giacco, Eric J.
影响因子：
16.2
作者：
Pladevall, M;Williams, LK;Lafata, JE
通讯作者：
Lafata, JE
影响因子：
5.1
作者：
OHKUBO, Y;KISHIKAWA, H;SHICHIRI, M
通讯作者：
SHICHIRI, M
影响因子：
9.3
作者：
Mandl KD;Mandel JC;Kohane IS
通讯作者：
Kohane IS