First-line Diabetes Rx Failure Attributed to Nonadherence

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Second-line treatment often initiated without evidence of recommended use of first-line treatment.
Second-line treatment often initiated without evidence of recommended use of first-line treatment.

(HealthDay News) -- Apparent diabetes treatment failures may in fact be attributable to nonadherence, according to a study published online in Diabetes Care.

Yi-Ju Tseng, PhD, from Boston Children's Hospital, and colleagues retrospectively analyzed unidentifiable member claims data from 52,544 individuals covered by Aetna who had two physician claims or one hospitalization with a type 2 diabetes diagnosis (2010 to 2015).

The researchers found that of 22,956 patients given second-line treatment, only 8.2% had evidence of recommended use of metformin in the prior 60 days, and 28.0% had no prior claims evidence of having taken metformin. Only 49.5% of patients could have had recommended use. An additional second-line antihyperglycemic medication or insulin was more likely in patients given their initial second-line medication without evidence of recommended use of metformin (P < 0.001).

"Despite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common," the authors write. "Point-of-care and population-level processes are needed to monitor and improve guideline adherence."

Reference

Tseng YJ, Steinberg G, Fox KP, Armstrong J, and Mandl KD. Antihyperglycemic Medications: A Claims-Based Estimate of First-Line Therapy Use Before Initialization of Second-Line Medications. Diab Care. doi: 10.2337/dc17-0213

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