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Cited by 306Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006–2013

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Lipska, Kasia J., Yao, Xiaoxi, Herrin, Jeph, McCoy, Rozalina G., Ross, Joseph S., Steinman, Michael A., Inzucchi, Silvio E., Gill, Thomas M. +2 more·2017·Diabetes Care
DOI 10.2337/dc16-0985PMC PMC5360291
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Abstract

OBJECTIVE: To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS: Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18–44, 45–64, 65–74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more). RESULTS: From 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36). CONCLUSIONS: During the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged.

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  • In a population-based study of 1.66 million people filling at least 1 glucose-lowering medication prescription, the rate of severe hypoglycemia per 100 person-years was 2.3 for people 75 years and older, 1.3 for those aged 64 to 75 years, and 0.9 for younger ages.

    “In a population-based study of 1.66 million people filling at least 1 glucose-lowering medication prescription, the rate of severe hypoglycemia per 100 person-years was 2.3 for people 75 years and older, 1.3 for those aged 64 to 75 years, and 0.9 for younger ages.121”

    From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [121]

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  • A meta-analysis of 7 trials of 6 injectable GLP-1RAs and 1 oral GLP-1RA among 56 004 participants with type 2 diabetes (76% with established cardiovascular disease) over a median follow-up of 1.3 to 5.4 years reported a reduction in both the primary major adverse cardiovascular events outcome (10.5% with GLP-1RA treatment vs 11.8% with placebo; hazard ratio, 0.88 [95% CI, 0.82-0.94]) and secondary

    “Similarly, a meta-analysis of 7 trials of 6 injectable GLP-1RAs and 1 oral GLP-1RA among 56 004 participants with type 2 diabetes (76% with established cardiovascular disease) over a median follow-up of 1.3 to 5.4 years reported a reduction in both the primary major adverse cardiovascular events outcome (10.5% with GLP-1RA treatment vs 11.8% with placebo; hazard ratio, 0.88 [95% CI, 0.82–0.94])”

    From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [108]

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  1. 2015, Diabetes Care, 38, S1

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Authors
Lipska, K. J., Yao, X., Herrin, J., McCoy, R. G., Ross, J. S., Steinman, M. A., Inzucchi, S. E., Gill, T. M., Krumholz, H. M., & Shah, N. D.
Affiliations
  • Yale University (US)
  • Mayo Clinic (US)
  • Yale New Haven Hospital (US)
  • University of California, San Francisco (US)
Corresponding author
Lipska, Kasia J.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-09-22
Volume
40
Issue
4
Pages
468-475
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc16-0985
PMC
PMC5360291
OpenAlex
W2523617397
Semantic Scholar
6b4700268ff332c2ae444b5f7bdbed9cf6cd276e
Cited by
306
References
44
Citations by year
2026: 4 · 2025: 13 · 2024: 22 · 2023: 40 · 2022: 34 · 2021: 37 · 2020: 44 · 2019: 40 · 2018: 44 · 2017: 26 · 2016: 1
FWCI
37.16
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 180 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Center for Advancing Translational Sciences (UL1 TR000135)
  • National Institute on Aging (K23AG048359, P30AG021342, K24AG049057, P30AG044281, K07AG3587)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, glucose-lowering medications, drug use trends, glycemic control, HbA1c, severe hypoglycemia, metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, insulin, comorbidities, Medicare Advantage
MeSH terms
Adolescent, Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Drug Utilization, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Metformin, Middle Aged, Retrospective Studies, Sulfonylurea Compounds, Comorbidity, Logistic Models, Thiazolidinediones, Dipeptidyl-Peptidase IV Inhibitors, Young Adult

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