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Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006–2013
Open accessAbstract
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.121”
From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [121]
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“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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Metadata
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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