Second-Line Antidiabetic Agent Order Patterns in Patients With Type 2 Diabetes Across Healthplan Types

OBJECTIVES: A sizable proportion of patients with type 2 diabetes (T2D) at low socioeconomic status (SES) may not take the advantage of the recently advanced antidiabetic medication (ADM) due to a limited health and pharmacy plan coverage. The aim of this study was to longitudinally assess the patterns of second-line (2L) ADM use in underinsured patients.

METHODS: We performed a retrospective study using healthcare records obtained from the University of Illinois Hospital and Health Sciences System. Eligible patients were adults with T2D who had taken first-line metformin and received treatment intensification (TI). Proportion of 2L-ADM with sodium-glucose cotransporter-2 inhibitor (SGLT2i) or glucagon-like peptide-1 receptor agonist (GLP1Ra) were summarized in the underinsured patient group, defined by Medicaid or no evident health coverage, and compared with the proportion out of patients with commercial healthcare coverage. Analysis was partitioned by every two calendar-year intervals from January 2013.

RESULTS: The analytic cohort consisted of 1,131 underinsured and 768 patients having commercial coverage. While the proportion of 2L-ADM with SGLT2i or GLP1Ra out of the commercially insured group increased from 12.9% to 32.2%, 46.4%, 52.0% and 70.0% for the respective two-year intervals, underinsured patients were less prescribed with the ADM classes with the respective proportions of 8.7%, 14.8%, 24.5%, 34.2%, and 54.9%. Delay in the uptake of SGLT2i or GLP1Ra among the underinsured group was consistently observed when the analysis was limited to either of the medication classes. The differences in the 2L-ADM patterns were continuously significant (p<0.05) in 2015 onward.

CONCLUSIONS: While American Diabetes Association has endorsed both GLP1Ra and SGLT2i as a preferred 2L option since 2015, the uptake of the recently advanced ADMs differed by healthplan type. Further study into the underlying cause and rationale behind the treatment gaps, besides the drug coverage, across the insurance type and SES is warranted.