Treatment Discontinuation of Oral Hypoglycemic Agents and Healthcare Utilization among Patients with Diabetes

• Published in: Journal of diabetes and its complications Vol. 30; no. 8; pp. 1443 - 1451
• Main Authors: Reynolds, Kristi, PhD, An, JaeJin, PhD, Wu, Jun, MD, Harrison, Teresa N., SM, Wei, Rong, MA, Stuart, Bruce, PhD, Martin, John P., MD, Wlodarczyk, Catherine S., MPH, Rajpathak, Swapnil N., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Chronic illnesses; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Endocrinology & Metabolism; Ethnicity; Female; Gastrointestinal surgery; Health care; Humans; Hypoglycemic Agents - therapeutic use; Laboratories; Male; Medical records; Medication Adherence; Middle Aged; Oral antihyperglycemics; Oral hypoglycemic agents; Patient Acceptance of Health Care; Patients; Retrospective Studies; Studies; Treatment adherence/compliance; Type 2 diabetes; Young Adult; United States > US; Oral Hypoglycemic Agents; Medication Adherence; Treatment Adherence/Compliance; Type 2 Diabetes; Oral Antihyperglycemics; Medication adherence; Type 2 diabetes; Oral hypoglycemic agents; Oral antihyperglycemics; Treatment adherence/compliance
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2016.07.021

Abstract Aims To investigate the discontinuation of oral antihyperglycemic agents (OHA), examine factors associated with OHA discontinuation, and the effect of OHA discontinuation on glycemic control and healthcare utilization among diabetes patients prescribed dual OHA therapy. Methods We identified 23,612 adult patients aged > 18 years with a diagnosis of type 2 diabetes who initiated dual OHA therapy between 1/1/2005–6/30/2010. The date of initiation of the second OHA was defined as the index date. Discontinuation was defined as a gap > 1.5 times the last days' supply without subsequent reinitiation. Results Over 24 months, 16.9% discontinued 1 OHA and 9.2% discontinued both. Patients who discontinued were more likely to be female, younger, Black or of Hispanic ethnicity, have more comorbidities, higher medication co-pays, start both OHAs together, have higher healthcare utilization before the index date and less likely to use prescription mail order compared with patients who did not discontinue. In multivariable regression models, patients who discontinued were more likely to be hospitalized or have emergency department visits during follow-up. Conclusions Discontinuation of OHAs is common among patients with diabetes and is associated with several patient factors and increased healthcare utilization. Future research should further examine reasons for OHA discontinuation.