Tags

Type your tag names separated by a space and hit enter

Characteristics Associated with the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes.
Clin Ther. 2017 Dec; 39(12):2399-2408.CT

Abstract

PURPOSE

The objective of this retrospective observational study was to describe and identify clinical and demographic characteristics associated with the choice of first injectable therapy (glucagon-like peptide-1 receptor agonist [GLP-1-RA] or basal insulin) among patients with type 2 diabetes mellitus (T2DM).

METHODS

This analysis included adults naive to injectable therapy with T2DM who initiated a GLP-1-RA or basal insulin (index date) between November 2014 and February 2016 using data from the Practice Fusion Electronic Health Record database. Patients with T2DM, ≥1 office visit between 6 and 18 months before the index date, and with ≥1 glycosylated hemoglobin (HbA1c) result in the 6-month preindex (baseline) period were included. A generalized boosted regression model was used to determine the patient characteristics most influential in the selection of a GLP-1-RA or basal insulin as first injectable therapy. Sensitivity analysis was performed by using bootstrapped logistic regression.

FINDINGS

The study included 3546 and 7507 GLP-1-RA and basal insulin initiators, respectively. At baseline, GLP-1-RA initiators were significantly younger (mean, 58 vs 63 years), had lower HbA1c values (mean, 8.2% vs 9.1%), lower Diabetes Complications Severity Index (DCSI) scores (mean, 1.0 vs 1.7), and a higher body mass index (BMI) (mean, 36 vs 33 kg/m[2]) compared with basal insulin initiators. Variables selected by using the generalized boosted regression model with the highest relative importance (≥5%) in the selection of GLP-1-RA or basal insulin were HbA1c level (20.43%), BMI (17.73%), age (12.21%), prior prescription of a sodium-glucose cotransporter-2 inhibitor (9.17%), and DCSI score (8.39%). The same variables, as well as race, were selected by using stepwise logistic regression in all the bootstrapped samples. Patients who were older (adjusted odds ratio [OR], 0.975 [95% CI, 0.971-0.979]) and had higher HbA1c values (OR, 0.741 [95% CI, 0.721-0.761]) and DCSI scores (OR, 0.870 [95% CI, 0.848-0.892]) were significantly less likely to be prescribed a GLP-1-RA compared with basal insulin. Patients with higher BMI (OR, 1.046 [95% CI, 1.040-1.053]) and previous prescription of sodium-glucose cotransporter-2 inhibitors (OR, 2.633 [95% CI, 2.224-2.982]) were significantly more likely to be prescribed a GLP-1-RA.

IMPLICATIONS

The clinically relevant differences observed between the 2 patient populations suggest that GLP-1-RAs and basal insulin are prescribed to different types of patients with T2DM. Examining patients' demographic and clinical characteristics may be important in assisting physicians in the choice of patient-centered injectable treatment regimens.

Authors+Show Affiliations

Eli Lilly and Company, Toronto, Ontario, Canada. Electronic address: yu_maria@lilly.com.Eli Lilly and Company, Corporate Center, Indianapolis, Indiana.Lilly USA, LLC, Corporate Center, Indianapolis, Indiana.Practice Fusion, San Francisco, California.Practice Fusion, San Francisco, California.Practice Fusion, San Francisco, California.Lilly USA, LLC, Corporate Center, Indianapolis, Indiana.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29196084

Citation

Yu, Maria, et al. "Characteristics Associated With the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes." Clinical Therapeutics, vol. 39, no. 12, 2017, pp. 2399-2408.
Yu M, Mody R, Landó LF, et al. Characteristics Associated with the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes. Clin Ther. 2017;39(12):2399-2408.
Yu, M., Mody, R., Landó, L. F., Shui, A., Kallenbach, L., Slipski, L., & de Oliveira, C. P. (2017). Characteristics Associated with the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes. Clinical Therapeutics, 39(12), 2399-2408. https://doi.org/10.1016/j.clinthera.2017.11.001
Yu M, et al. Characteristics Associated With the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes. Clin Ther. 2017;39(12):2399-2408. PubMed PMID: 29196084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics Associated with the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes. AU - Yu,Maria, AU - Mody,Reema, AU - Landó,Laura Fernández, AU - Shui,Amy, AU - Kallenbach,Lee, AU - Slipski,Lukas, AU - de Oliveira,Carolina Piras, Y1 - 2017/11/28/ PY - 2017/08/03/received PY - 2017/11/03/revised PY - 2017/11/07/accepted PY - 2017/12/3/pubmed PY - 2018/5/31/medline PY - 2017/12/3/entrez KW - GLP-1 receptor agonist KW - basal insulin KW - real-world KW - type 2 diabetes mellitus SP - 2399 EP - 2408 JF - Clinical therapeutics JO - Clin Ther VL - 39 IS - 12 N2 - PURPOSE: The objective of this retrospective observational study was to describe and identify clinical and demographic characteristics associated with the choice of first injectable therapy (glucagon-like peptide-1 receptor agonist [GLP-1-RA] or basal insulin) among patients with type 2 diabetes mellitus (T2DM). METHODS: This analysis included adults naive to injectable therapy with T2DM who initiated a GLP-1-RA or basal insulin (index date) between November 2014 and February 2016 using data from the Practice Fusion Electronic Health Record database. Patients with T2DM, ≥1 office visit between 6 and 18 months before the index date, and with ≥1 glycosylated hemoglobin (HbA1c) result in the 6-month preindex (baseline) period were included. A generalized boosted regression model was used to determine the patient characteristics most influential in the selection of a GLP-1-RA or basal insulin as first injectable therapy. Sensitivity analysis was performed by using bootstrapped logistic regression. FINDINGS: The study included 3546 and 7507 GLP-1-RA and basal insulin initiators, respectively. At baseline, GLP-1-RA initiators were significantly younger (mean, 58 vs 63 years), had lower HbA1c values (mean, 8.2% vs 9.1%), lower Diabetes Complications Severity Index (DCSI) scores (mean, 1.0 vs 1.7), and a higher body mass index (BMI) (mean, 36 vs 33 kg/m[2]) compared with basal insulin initiators. Variables selected by using the generalized boosted regression model with the highest relative importance (≥5%) in the selection of GLP-1-RA or basal insulin were HbA1c level (20.43%), BMI (17.73%), age (12.21%), prior prescription of a sodium-glucose cotransporter-2 inhibitor (9.17%), and DCSI score (8.39%). The same variables, as well as race, were selected by using stepwise logistic regression in all the bootstrapped samples. Patients who were older (adjusted odds ratio [OR], 0.975 [95% CI, 0.971-0.979]) and had higher HbA1c values (OR, 0.741 [95% CI, 0.721-0.761]) and DCSI scores (OR, 0.870 [95% CI, 0.848-0.892]) were significantly less likely to be prescribed a GLP-1-RA compared with basal insulin. Patients with higher BMI (OR, 1.046 [95% CI, 1.040-1.053]) and previous prescription of sodium-glucose cotransporter-2 inhibitors (OR, 2.633 [95% CI, 2.224-2.982]) were significantly more likely to be prescribed a GLP-1-RA. IMPLICATIONS: The clinically relevant differences observed between the 2 patient populations suggest that GLP-1-RAs and basal insulin are prescribed to different types of patients with T2DM. Examining patients' demographic and clinical characteristics may be important in assisting physicians in the choice of patient-centered injectable treatment regimens. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/29196084/Characteristics_Associated_with_the_Choice_of_First_Injectable_Therapy_Among_US_Patients_With_Type_2_Diabetes_ DB - PRIME DP - Unbound Medicine ER -