Disease Management in Adults with Type 1 Diabetes Who Have a Prior Type 2 Diabetes Misdiagnosis and Recorded HbA1c in a US Managed Care Population
Author(s)
Diana Brixner, RPh, PhD1, Tariku J. Beyene, PhD2, Malvika Venkataraman, MSc2, Chia-Chen Teng, MSc2, Hung-Yuan P. Chen, MSc2, Hiangkiat Tan, MSc2, Laura R. Wilson, PharmD3, Jessica Dunne, Phd3, Maribel Borysyuk, MSc3, Daniel Malone, BS, RPh, PhD1.
1University of Utah, Salt Lake City, UT, USA, 2Carelon Research, Wilmington, DE, USA, 3Sanofi, Morrisstown, NJ, USA.
1University of Utah, Salt Lake City, UT, USA, 2Carelon Research, Wilmington, DE, USA, 3Sanofi, Morrisstown, NJ, USA.
OBJECTIVES: To examine disease management in adults with type 1 diabetes (T1D) with prior type 2 diabetes (T2D) misdiagnosis.
METHODS: This observational cohort study assessed administrative claims from the Carelon Healthcare Integrated Research Database between Oct 1, 2015, and Dec 31, 2023. Adults (≥18 years) with ≥2 outpatient claims for T1D 30-183 days apart or ≥1 inpatient claim were identified. First T1D diagnosis was the index date. Individuals required ≥12 months’ continuous medical and pharmacy benefit prior to (baseline) and after index (follow-up). Individuals with ≥2 T2D diagnoses or only 1 T1D diagnosis during 12-month follow-up, or secondary diabetes or pregnancy during 12-month baseline, were excluded. Adults with newly-diagnosed T1D with a prior T2D misdiagnosis during baseline were assessed. In this exploratory analysis, individuals were also required to have ≥1 HbA1c measurement during baseline and ≥3 months post-index. Blood sugar control and medication use were assessed at baseline and follow-up.
RESULTS: Overall, 763 adults with T1D had a prior T2D misdiagnosis (44% female; mean [SD] age: 50 [14] years; mean [SD] baseline and follow-up duration: 5.0 [3.2] years and 3.6 [1.7] years). At baseline, 34% of patients had a HbA1c measurement of ≥9%; this decreased to 29% at 3-month follow-up and to 19% at 36-month follow-up. After T1D diagnosis, use of insulin increased (baseline: 61%; follow-up: 71%) and use of metformin (baseline: 40%; follow-up: 31%) or non-glucagon-like peptide-1 receptor agonist oral antidiabetics (baseline: 40%; follow-up: 26%) decreased.
CONCLUSIONS: Prior to index T1D diagnosis, a substantial proportion of patients had elevated blood glucose levels; this proportion decreased following correct T1D diagnosis, which may suggest improved glycemic control over time. Medication use at follow-up aligned with T1D-related guidance, emphasizing a need for improved diagnostics to ensure appropriate management.
METHODS: This observational cohort study assessed administrative claims from the Carelon Healthcare Integrated Research Database between Oct 1, 2015, and Dec 31, 2023. Adults (≥18 years) with ≥2 outpatient claims for T1D 30-183 days apart or ≥1 inpatient claim were identified. First T1D diagnosis was the index date. Individuals required ≥12 months’ continuous medical and pharmacy benefit prior to (baseline) and after index (follow-up). Individuals with ≥2 T2D diagnoses or only 1 T1D diagnosis during 12-month follow-up, or secondary diabetes or pregnancy during 12-month baseline, were excluded. Adults with newly-diagnosed T1D with a prior T2D misdiagnosis during baseline were assessed. In this exploratory analysis, individuals were also required to have ≥1 HbA1c measurement during baseline and ≥3 months post-index. Blood sugar control and medication use were assessed at baseline and follow-up.
RESULTS: Overall, 763 adults with T1D had a prior T2D misdiagnosis (44% female; mean [SD] age: 50 [14] years; mean [SD] baseline and follow-up duration: 5.0 [3.2] years and 3.6 [1.7] years). At baseline, 34% of patients had a HbA1c measurement of ≥9%; this decreased to 29% at 3-month follow-up and to 19% at 36-month follow-up. After T1D diagnosis, use of insulin increased (baseline: 61%; follow-up: 71%) and use of metformin (baseline: 40%; follow-up: 31%) or non-glucagon-like peptide-1 receptor agonist oral antidiabetics (baseline: 40%; follow-up: 26%) decreased.
CONCLUSIONS: Prior to index T1D diagnosis, a substantial proportion of patients had elevated blood glucose levels; this proportion decreased following correct T1D diagnosis, which may suggest improved glycemic control over time. Medication use at follow-up aligned with T1D-related guidance, emphasizing a need for improved diagnostics to ensure appropriate management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD65
Topic
Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)