OBJECTIVES:  To describe prognostic characteristics of patients with type-2-diabetes (T2D) prior to initiating anti-diabetes medications (ADM). METHODS:  Humedica EHR database was used to describe characteristics of adult ADM initiators between 2006 and 2012. ADM classes included metformin, sulfonylureas, thiazolidinediones (TZD), incretin enhancers (incretins), and insulin. Study follow-up was divided into two 12-month periods prior to ADM initiation date (index date). T2D characteristics were measured during the 12-month period farthest from index date to reflect disease progression latency and impact on future treatment choices. T2D severity and complications included diabetes duration, HbA1c, micro/macrovascular complications, and healthcare utilization indices. RESULTS:  479,099 ADM initiators were studied (mean age 58 years, SD=12; mean T2D duration 2.7 years, SD=1.5), corresponding to 38% metformin; 22% sulfonylureas; 10% TZD; 13% incretins; and 17% insulin initiators. There were significant differences between ADM groups (p value≤0.001). Initiators of incretins and insulin had worse T2D compared to other ADM initiators. Mean HbA1c (SD) for incretins and insulin users were 6.7% (1.8) and 6.6% (2.4), respectively; compared to metformin 6.4% (1.6) and other ADM users 6.6% (2.0). 11% of incretins and insulin users had poorly controlled diabetes, compared to 3% metformin, 5% sulfonylureas, and 6% TZD users. Micro/macrovascular complications were more in incretins and insulin initiators (retinopathy, 1.7% and 2.4%; neuropathy, 2.7% and 3%; nephropathy, 1.9% and 2.4%; heart failure, 2% and 2.8%; coronary artery disease, 2.5% and 2.4%) than other ADM initiators, e.g. metformin (0.6%; 0.8%; 0.4%; 0.9%; and 1.4%, respectively). General and diabetes-related healthcare utilization was higher in incretins and insulin users. CONCLUSIONS:

History of diabetes severity and complications should be taken into account when selecting comparison groups. Comparing insulin to incretins is more appropriate than to other ADM.