Assessing use of patient-focused pharmacotherapy in glycemic management through the Diabetes Collaborative Registry (DCR)

• Type of Material: Article
• Authors: Suzanne V. Arnold, University of Missouri Kansas City; Darren K. McGuire, University of Texas Southwestern; Silvio E. Lnzucchi, Yale University; Fengming Tang, University of Missouri Kansas City; Sanjeev N. Mehta, Joslin Diabetes Center; Carolyn S. P. Lam, National University of Singapore; Abhinav Goyal, Emory University; Laurence Sperling, Emory University; Nathan D. Wong, University of California Irvine; Niklas Hammar, AstraZeneca; Peter Fenici, AstraZeneca; Mikhail Kosiborod, University of Missouri Kansas City
• Language: English
• Date: 2018-11-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jdiacomp.2018.02.009
• Title of Journal or Parent Work: JOURNAL OF DIABETES AND ITS COMPLICATIONS
• Volume: 32
• Issue: 11
• Start Page: 1035
• End Page: 1039
• Grant/Funding Information: The Diabetes Collaborative Registry is funded by AstraZeneca (founding sponsor) and Boehringer Ingelheim. Both corporate sponsors contributed scientific expertise to the design of the registry. Co-authors from AstraZeneca have reviewed and edited the manuscript for intellectual content; however, the sponsors of the registry had no role in the final review and approval of the manuscript for submission.
• Keywords: Personalized medicine; Medications; Science & Technology; GLUCOSE-LOWERING DRUGS; TYPE-2; HYPERGLYCEMIA; Diabetes mellitus; Patient safety; SULFONYLUREAS; MELLITUS; Endocrinology & Metabolism; RISK; METFORMIN; Life Sciences & Biomedicine; MONOTHERAPY; MORTALITY; CARDIOVASCULAR OUTCOMES; Registries
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Pharmacology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Although practice guidelines stress individualization of glucose management in patients with type 2 diabetes (T2D), the extent to which providers take patient factors into account when selecting medications is not well known. Methods: Diabetes Collaborative Registry (DCR) is an outpatient diabetes registry including primary care, cardiology, and endocrinology practices. T2D medications were grouped as those which may be suboptimal for key patient subgroups, and we examined patient factors associated with use of these agents using hierarchical, multivariable Poisson models. Results: In DCR, 157,551 patients from 374 US practices were prescribed a glucose-lowering medication. Patients with morbid obesity were more likely treated with medications prone to cause weight gain (relative rate [RR] 1.09, 95% CI 1.07–1.11). Older patients were more likely to be treated with medications with increased risk of hypoglycemia (RR 1.04 per 5 years, 95% CI 1.04–1.05). Patients with CKD 4/5 were less likely to be treated with agents with known risk in patients with advanced CKD (RR 0.74, 95% CI 0.71–0.77). Patients with coronary artery disease were no more or less likely to be treated with medications with potential cardiovascular safety issues (RR 0.99, 95% CI 0.96–1.01). Conclusions: We observed some targeted use of glucose-lowering therapies in certain subgroups but also identified potential opportunities for better personalization of treatment. Data sources such as the DCR can highlight potential areas for improving targeted approaches to pharmacologic therapy in order to optimize selection of patients most likely to benefit (and least likely to be harmed) from treatments.