OBJECTIVES: In 2010, the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) updated their guidelines for treatment of type-2 diabetic patients. This study assessed the selection of initial antidiabetic pharmacotherapy among newly diagnosed with type-2 diabetes patients from 2010- 2016 in a commercial health plan in the United States.

METHODS: A retrospective cohort study was conducted using a large commercial health plan claims database. Patients with a first diagnosis of diabetes from 2010 to 2016 were identified by the International Classification of Disease, ninth & tenth revisions, Clinical Modification diagnostic codes. We included patients aged ≥18 years, with normal renal and liver function, HbA1C >6.4%, and with at least 1 year of continuous enrollment in the health plan before the first antidiabetic prescription. We excluded pregnant woman. Data were classified based on HbA1C level, pharmacological class, active ingredient, and strength. Differences in utilization of initial antidiabetic pharmacotherapy according to the HbA1C levels were evaluated using Chi-squared test.

RESULTS: From 2010 to 2016, 71,739 newly diagnostic type-2 diabetic patients were prescribed antidiabetic pharmacotherapy. A total of 70,228 (97.9%) patients started pharmacotherapy with oral antidiabetic drugs, and 1,697 (2.4%) patients started pharmacotherapy with insulin. Most patients were treated with biguanides class (metformin) (93.1%) and sulfonylurea class (5.5%). The strength of metformin, the use a drug combination and the use of insulin were positively associated with the HbA1C level (p <0.001).

CONCLUSIONS: Most newly diagnosed type-2 diabetic patients were prescribed metformin which is the preferred agent for initial treatment recommended by the ADA/AACE guidelines. The HbA1C levels influenced the choice of initial antidiabetic pharmacotherapy and strength, and the use of a drug combination.