OBJECTIVES: To explore the trend of antidiabetic medications utilization and to determine the association between antidiabetic medication use, glycemic control, and complications among T2DM patients in the United States.

METHODS: Cross-sectional secondary data analysis was conducted using the National health and nutrition examination survey (NHANES) database. All Type 2 diabetes patients who were on antidiabetic medications and interviewed from 2013 to 2018 were included. The primary outcome was glycemic control. Good glycemic control was defined as having HbA1C below 7. Antidiabetic medication utilization were explored based on antidiabetic type and demographic characteristics. Kidney disease and retinopathy were evaluated as diabetes-related complications. Logistic regression was conducted to determine the association between antidiabetics, glycemic control, and complications.

RESULTS: Overall, 1837 patients were identified with T2DM using ICD10 codes. Metformin was the most prescribed medication (38%) followed by sulfonylureas (28%). However, data was only available for 933 (51%) patients for the analysis of glycemic control and complications. Of which, 54% had controlled diabetes. Patients on metformin (21.97%) had good glycemic control. Binary logistic regression found that the likelihood of controlled diabetes was lower in sulfonylurea users 0.319 [95%:0.201-0.506] and insulin users 0.194[0.122-0.308]. The risk of retinopathy reduced by 30% among females, AOR: 0.675[95%CI 0.485-0.939]. Patients on sulfonylurea 2.505[95%CI 1.558-4.028] and insulin 5.137[3.227-8.18] had higher odds of retinopathy. The odds of kidney disease increased in patients who were above 65 years old, AOR: 3.039 [95%CI: 1.22-7.53].

CONCLUSIONS: Metformin was the most prescribed medication among type 2 diabetes patients. Around half of the respondents had controlled diabetes. Patients who were on metformin had good glycemic control. Sulfonylureas and insulin increased the risk of uncontrolled diabetes and complications. It is imperative to optimize anti-diabetes therapy to achieve reasonable level of glycemic control and to minimize complications.