| Progression to Insulin for Patients with Diabetes Mellitus Using the Texas Medicaid Database. | |
| | |
MedLine Citation:
|
PMID: 22101160 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
BACKGROUND: Patients newly diagnosed with type 2 diabetes mellitus generally initiate therapy with either metformin [Met] or a sulfonylurea [SU] drug, followed by the addition of a second agent (Met, an SU drug, or a thiazolidinedione [TZD] drug) if the diabetes is not well controlled. If necessary, the usual third line of treatment is the addition of insulin. OBJECTIVE: The purpose of our study was to compare the progression to insulin among 3 cohorts receiving the oral antidiabetic (OAD) drug combinations Met/SU, Met/TZD, or SU/TZD. METHODS: This study used data from the Texas Medicaid database. The date of addition of a second OAD was considered a patient's index date and patients were followed for up to 5 years. Cox proportional hazards regression compared the progression to first insulin use among cohorts, using the Met/SU cohort as the reference group, while adjusting for demographics, comorbidities, and propensity scores. RESULTS: A total of 4083 patients were included in the study (Met/SU = 2872, Met/TZD = 438, and SU/TZD = 773). Insulin was added to the medication regimen of patients by the end of follow-up in 19.7% of the Met/SU cohort, 17.6% of the Met/TZD cohort, and 26.3% of the SU/TZD cohort. The adjusted Cox proportional model estimated that patients in the SU/TZD cohort had a 40% higher probability of progression to insulin than patients in the Met/SU cohort (odds ratio [OR] = 1.40; 95% CI, 1.19-1.64), whereas there was no significant difference between the Met/TZD and Met/SU cohorts (OR = 0.85; 95% CI, 0.67-1.08). CONCLUSIONS: It appears that mechanism of action may play a role in progression to insulin for concomitant OAD agents. A slower progression to insulin was seen for patients receiving a paired sensitizer regimen (ie, Met/TZD) compared with those receiving a secretagogue sensitizer regimen (ie, SU/TZD). |
| | |
Authors:
|
Karen L Rascati; Kristin M Richards; Debra Lopez; Lung-I Cheng; James P Wilson |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-11-17 |
Journal Detail:
|
Title: Clinical therapeutics Volume: - ISSN: 1879-114X ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
|
Created Date: 2011-11-21 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 7706726 Medline TA: Clin Ther Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved. |
Affiliation:
|
The University of Texas at Austin College of Pharmacy, Austin, Texas. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Cre-mediated cell ablation contests mast cell contribution in models of antibody- and T cell-mediate...
Next Document: Double-Blind, Placebo-Controlled, Randomized Pilot Study of Cerebral Blood Flow Patterns Employing S...