Presentation (CTI)

OBJECTIVES: Examine the characteristics of adults with type 2 diabetes (T2D) who are not initially treated with a glucose-lowering agent (GLA).
METHODS: Optum® Market Clarity data from January 2013 through September 2023 was used. The study included non-pregnant adults with T2D who were continuously insured from 1 year prior through 5 years post diagnosis. Individuals included did not fill a prescription for a GLA one year prior and post diagnosis. Characteristics were examined descriptively, and Cox proportional hazards models examined time to initiation on a GLA.
RESULTS: There were 186,259 adults with T2D; 56.7% (N=105,533) were untreated with a GLA one year pre and post diagnosis and included in the final cohort. Of these 105,533 adults (median age = 59.6 years; 51.4% female), 75.0% did not fill any GLA prescription in the 5-year post-period. Most individuals who were treated with a GLA initiated therapy with metformin (72.9%). Examining a subset of individuals who had their body mass index (BMI) measured during the first-year of the post-period (N=40,298) revealed that higher BMI was associated with a significantly higher hazard ratio of initiation on a GLA (P<0.0001). Specifically, compared to being identified as under/normal weight, people classified with overweight, obesity class I, II and III had hazards of 1.32 (95% CI 1.21-1.45), 1.90 (95% CI 1.75-2.08), 2.39 (95% CI 2.18 - 2.61) and 2.68 (95% CI 2.44-2.93), respectively.
CONCLUSIONS: Over 50% of adults with T2D are untreated in the first-year post diagnosis and, while higher BMI was associated with an increased likelihood of GLA initiation, the majority of individuals remained untreated for up to 5 years. Given that American Diabetes Association guidelines suggest pharmacotherapy at time of diagnosis for most adults, the findings suggest treatment inertia and may represent a potential unmet need in the years immediately after diagnosis of T2D.