PMID- 26154837
OWN - NLM
STAT- MEDLINE
DCOM- 20160512
LR  - 20221207
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 31
IP  - 9
DP  - 2015
TI  - Historical cohort analysis of treatment patterns for patients with type 2 
      diabetes initiating metformin monotherapy.
PG  - 1703-16
LID - 10.1185/03007995.2015.1067194 [doi]
AB  - OBJECTIVE: To describe treatment regimen changes of patients with type 2 diabetes 
      mellitus (T2DM) initiating metformin monotherapy, and assess factors associated 
      with those changes 12 months post-initiation. METHODS: Retrospective cohort 
      analysis of medical, pharmacy and laboratory claims of 17,527 Medicare Advantage 
      (MAPD) Humana members aged 18-89, who had >/=1 medical claim with primary diagnosis 
      or >/=2 medical claims with secondary diagnosis of T2DM (ICD-9-CM code 250.x0 or 
      250.x2) who filled an initial prescription for metformin (GPI code 2725) between 
      1 January 2008 and 30 September 2011. The main outcome measure was change in 
      metformin monotherapy during the 12 months following initiation. Factors 
      associated with treatment changes during follow-up were examined using Cox 
      proportional hazards regression models. RESULTS: Fifty-nine percent of patients 
      (mean age 69.6 years) remained on metformin monotherapy with no changes. 
      Discontinuation was the most common treatment change (33%), followed by addition 
      (5%), and switching (2%) to other antidiabetics. Of patients who discontinued 
      treatment (median time to discontinuation = 90 days), 61% did not reinitiate any 
      diabetic treatment during the follow-up period. Among patients who added or 
      switched to other antidiabetics, sulfonylureas were the most common addition or 
      replacement agent. Predictors of discontinuation were being female, Black or 
      Hispanic, low-income subsidy eligible, having higher initial out-of-pocket 
      metformin costs, or a diagnosis of depression. Discontinuation was less likely 
      during follow-up if patients had higher pre-index pill burdens or records of a 
      pre-index A1C screening test. A higher risk of discontinuation was observed for 
      patients with low baseline A1C. One study limitation was that exact 
      discontinuation dates could not be determined using claims. CONCLUSIONS: The 
      findings suggest that gender, race, ethnicity, depression, and low income status 
      were contributory factors to metformin discontinuation. More intensive monitoring 
      and treatment adjustments may be warranted for patients newly initiated on 
      metformin. This could ultimately improve morbidity, mortality, and costs 
      associated with poor glycemic control.
FAU - Hazel-Fernandez, Leslie
AU  - Hazel-Fernandez L
AD  - a a Comprehensive Health Insights Inc. , Louisville , KY , USA.
FAU - Xu, Yihua
AU  - Xu Y
AD  - a a Comprehensive Health Insights Inc. , Louisville , KY , USA.
FAU - Moretz, Chad
AU  - Moretz C
AD  - a a Comprehensive Health Insights Inc. , Louisville , KY , USA.
FAU - Meah, Yunus
AU  - Meah Y
AD  - b b Humana Inc. , Louisville , KY , USA.
FAU - Baltz, Jean
AU  - Baltz J
AD  - b b Humana Inc. , Louisville , KY , USA.
FAU - Lian, Jean
AU  - Lian J
AD  - c c Novo Nordisk Inc. , Plainsboro , NJ , USA.
FAU - Kimball, Edward
AU  - Kimball E
AD  - c c Novo Nordisk Inc. , Plainsboro , NJ , USA.
FAU - Bouchard, Jonathan
AU  - Bouchard J
AD  - c c Novo Nordisk Inc. , Plainsboro , NJ , USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150827
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Sulfonylurea Compounds)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - *Diabetes Mellitus, Type 2/blood/drug therapy/ethnology
MH  - Drug Monitoring
MH  - Drug Substitution/statistics & numerical data
MH  - Drug Therapy, Combination/methods/statistics & numerical data
MH  - Female
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage/adverse effects
MH  - Male
MH  - *Metformin/administration & dosage/adverse effects
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Sulfonylurea Compounds/administration & dosage/adverse effects
MH  - United States/epidemiology
MH  - Withholding Treatment/statistics & numerical data
OTO - NOTNLM
OT  - Adults
OT  - Age 65 plus
OT  - Metformin therapeutic use
OT  - Type two diabetes mellitus
EDAT- 2015/07/15 06:00
MHDA- 2016/05/14 06:00
CRDT- 2015/07/09 06:00
PHST- 2015/07/09 06:00 [entrez]
PHST- 2015/07/15 06:00 [pubmed]
PHST- 2016/05/14 06:00 [medline]
AID - 10.1185/03007995.2015.1067194 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2015;31(9):1703-16. doi: 10.1185/03007995.2015.1067194. Epub 
      2015 Aug 27.