@article {635817, title = {National Rates of Initiation and Intensification of Antidiabetic Therapy Among Patients With Commercial Insurance}, journal = {Diabetes Care }, volume = {41}, number = {8}, year = {2018}, pages = {1776-1782}, abstract = {OBJECTIVE:Prompt\ initiation\ and\ intensification\ of\ antidiabetic\ therapy\ can delay or prevent complications from diabetes. We sought to understand the\ rates\ of and factors associated with the\ initiation\ and\ intensification\ of\ antidiabetic\ therapy\ among commercially insured\ patients\ in the U.S.RESEARCH DESIGN AND METHODS:Using 2008-2015\ commercial\ claims linked with laboratory and pharmacy data, we created an\ initiation\ cohort with no prior\ antidiabetic\ drug use and an HbA1c\ >=8\% (64 mmol/mol) and an\ intensification\ cohort of\ patients\ with an HbA1c>=8\% (64 mmol/mol) who were on a stable dose of one noninsulin diabetes drug. Using multivariable logistic regression, we determined the\ rates\ of and factors associated with\ initiation\ and\ intensification. In addition, we determined the percent of variation in treatment patterns explained by measurable patient factors.RESULTS:In the\ initiation\ cohort (n\ = 9,799), 63\% of\ patients\ received an\ antidiabetic\ drug within 6 months of the elevated HbA1c\ test. In the\ intensification\ cohort (n\ = 10,941), 82\% had their existing\ antidiabetic\ therapy\ intensified within 6 months of the elevated HbA1c\ test. Higher HbA1c\ levels, lower generic drug copayments, and more frequent office visits were associated with higher\ rates\ of both\ initiation\ and\ intensification. Better patient adherence prior to the elevated HbA1c\ level, existing\ therapy\ with a second-generation\ antidiabetic\ drug, and lower doses of existing\ therapy\ were also associated with\ intensification. Patient factors explained 7.96\% of the variation in\ initiation\ and 7.35\% of the variation in\ intensification.CONCLUSIONS:Approximately two-thirds of\ patients\ were newly initiated on\ antidiabetic\ therapy, and four-fifths of those already receiving\ antidiabetic\ therapy\ had it intensified within 6 months of an elevated HbA1c\ in a commercially insured population. Patient factors explain 7-8\% of the variation in diabetes treatment patterns.}, author = {Gilstrap LG and Mehrotra A and Bai B and Rose S and Blair RA and Chernew ME} }