PMID- 25068375
OWN - NLM
STAT- MEDLINE
DCOM- 20150714
LR  - 20221207
IS  - 1557-8593 (Electronic)
IS  - 1520-9156 (Linking)
VI  - 16
IP  - 12
DP  - 2014 Dec
TI  - Treatment patterns among older patients with type 2 diabetes in the United 
      States: a retrospective cohort study.
PG  - 833-9
LID - 10.1089/dia.2014.0039 [doi]
AB  - BACKGROUND: The American Diabetes Association consensus statement on the 
      treatment of type 2 diabetes mellitus (T2DM) in older patients highlights the 
      need for treatment pattern and effectiveness data from real-world settings and 
      populations. This retrospective cohort study assessed the relative frequency of 
      use of four commonly prescribed antihyperglycemia treatments for T2DM and 
      quantified their effectiveness up to 2 years post-initiation. SUBJECTS AND 
      METHODS: Within a large, U.S.-based, electronic health record database, we 
      investigated usage of insulin, sulfonylureas, glucagon-like peptide-1(GLP-1) 
      receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with 
      T2DM, focusing on those >/=65 years old, although younger patients were included 
      for comparative purposes. RESULTS: Inclusion criteria were met by 77,440 
      patients. Mean baseline glycosylated hemoglobin (HbA1c) levels for patients >/=65 
      years old varied among treatments: insulin (7.7% [61 mmol/mol]; n=3,311), 
      sulfonylureas (7.0% [53 mmol/mol]; n=5,706), GLP-1 receptor agonists (7.1% [54 
      mmol/mol]; n=260), and DPP-4 inhibitors (7.1% [54 mmol/mol]; n=1,096). Older 
      patients demonstrated good glycemic control at therapy initiation and were 
      prescribed glucose-lowering agents at lower HbA1c values compared with younger 
      patients. A large proportion of older patients were prescribed sulfonylureas 
      (56%) and insulin (34%) compared with GLP-1 receptor agonists (3.4%) and DPP-4 
      inhibitors (12%), despite the associated risk of hypoglycemia. CONCLUSIONS: 
      Patients initiating insulin and sulfonylureas demonstrated more sustained 
      glycemic control compared with GLP-1 receptor agonists and DPP-4 inhibitors. A 
      majority of older patients with T2DM was initiated on sulfonylureas and insulin 
      at relatively low levels of HbA1c, a practice not entirely consistent with the 
      recommendations of published guidelines.
FAU - Fu, Haoda
AU  - Fu H
AD  - 1 Eli Lilly and Company , Indianapolis, Indiana.
FAU - Curtis, Bradley H
AU  - Curtis BH
FAU - Schuster, Dara P
AU  - Schuster DP
FAU - Festa, Andreas
AU  - Festa A
FAU - Kendall, David M
AU  - Kendall DM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140728
PL  - United States
TA  - Diabetes Technol Ther
JT  - Diabetes technology & therapeutics
JID - 100889084
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (GLP1R protein, human)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Receptors, Glucagon)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Aging
MH  - Cohort Studies
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/adverse effects/therapeutic use
MH  - Electronic Health Records
MH  - Female
MH  - Glucagon-Like Peptide-1 Receptor
MH  - Glycated Hemoglobin/*analysis
MH  - Humans
MH  - Hyperglycemia/*prevention & control
MH  - Hypoglycemia/chemically induced/*prevention & control
MH  - Hypoglycemic Agents/adverse effects/*therapeutic use
MH  - Insulin/adverse effects/therapeutic use
MH  - Male
MH  - Practice Guidelines as Topic
MH  - *Practice Patterns, Physicians'
MH  - Receptors, Glucagon/agonists
MH  - Retrospective Studies
MH  - Sulfonylurea Compounds/adverse effects/therapeutic use
MH  - United States
EDAT- 2014/07/30 06:00
MHDA- 2015/07/15 06:00
CRDT- 2014/07/29 06:00
PHST- 2014/07/29 06:00 [entrez]
PHST- 2014/07/30 06:00 [pubmed]
PHST- 2015/07/15 06:00 [medline]
AID - 10.1089/dia.2014.0039 [doi]
PST - ppublish
SO  - Diabetes Technol Ther. 2014 Dec;16(12):833-9. doi: 10.1089/dia.2014.0039. Epub 
      2014 Jul 28.