OBJECTIVES: Diabetes is one of the most prevalent chronic diseases. This study aimed to examine geographical and temporal trends in utilization of antihyperglycemic therapies among the U.S. Medicaid population compared to diabetes prevalence at state-level using Geographic Information system.

METHODS: A descriptive, retrospective study design was performed for 2011,2014, and 2016. Study drugs were categorized into biguanides, sulfonylureas-meglitinides, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and insulins. Annual number of prescriptions for antihyperglycemic therapies were extracted from the national Medicaid pharmacy database provided by the Centers for Medicare & Medicaid. Spatial analysis using ArcMap 10.5.1 were performed to create choropleth maps for diabetes prevalence and point maps for total number of prescriptions for each antihyperglycemic therapy. The percent change in drug utilization was calculated per therapeutic class per state. Correlation between diabetes prevalence and antihyperglycemic therapies usage was also performed.

RESULTS: Utilization of most antihyperglycemic therapies increased from 2011 to 2016 at national level. States with high utilization trends were NY, CA, PA, NJ, AZ, FL, IL, OH, MA, and TX, ranging from 1 fold to 50 fold overall. The five most prescribed antihyperglycemic therapies in 2016 were biguanides (41.95%), long-acting insulins (18.9%), short-rapid-acting insulins (12.87%), sulfonylureas-meglitinides (11.37%), and DPP-4 inhibitors (7.87%). Rapidly increasing trends were for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors around all states. SGLT2-inhibitors usage in the eastern U.S. increased 4 to 25 fold higher than its use in 2014. Sulfonylureas-meglitinides usage decreased in the southeastern U.S. by 20%-58% in 2016.There was no correlation between diabetes prevalence and antihyperglycemic medications usage. Although diabetes prevalence was highest in the southern states, Antihyperglycemic therapy utilization in the south were less than other states.

CONCLUSIONS: Antihyperglycemic therapy usage grew rapidly in the east and southeast of the U.S. Geographical patterns of antihyperglycemic therapy utilization did not match geographical patterns of diabetes prevalence.