One-third of patients do not receive first-line drugs for diabetes

Approximately one-third of patients starting oral medication to treat diabetes did not receive the clinically recommended initial therapy with the drug metformin. That's according to a study published in The American Journal of Medicine.

The study by Brigham and Women's Hospital in Boston and Harvard University followed more than 250,000 patients, aged 18 to 100 years. All patients were newly initiated on oral hypoglycemic therapy over the course of the three-year study period.

The subgroup that did not receive metformin therapy constituted 35 percent of the study participants but comprised 66.3 percent of the total expenditures for hypoglycemic drugs in the entire cohort, according to a news article in Drug Topics.

Medicare patients less likely to start treatment

Researchers found that young patients, women, and patients receiving drug benefits through Medicare were least likely to start their diabetes treatment using metformin.

There are six classes of oral medications approved by the Food and Drug Administration to treat type 2 diabetes. All are known to be effective at lowering blood sugar, but clinical guidelines recommend metformin as the first-line drug for newly diagnosed type 2 diabetes.

During the study period, the proportion of patients initially treated with metformin increased from 51 percent to 65 percent. Prescriptions for sulfonylureas, the second most commonly used diabetes drug, decreased from 26 percent to 18 percent. The use of thiazolidinediones decreased significantly from 20.1 percent to 8.3 percent. Finally, prescriptions for dipeptidyl peptidase-4 inhibitors increased from 0.4 percent to 7.3 percent.

Implications for health care spending

These usage patterns have significant implications for health care spending costs. The study found that patients and insurers spent a combined $677 over a six-month period for patients initiated on alpha-glucosidase inhibitis, thiazolidinediones, meglitinides, or dipeptidyl peptidase-4 inhibitors.

This compares to $116 for patients initiated on metformin and $118 for patients initiated on a sulfonylurea, at a cost difference of about $1120 annually per patient.

Diabetes and pre-diabetes cost the US economy $218 billion in 2007, according to a study by The Lewin Group. That same study projected that those costs will increase to $336 billion by 2034.

Sources: The American Journal of Medicine, Drug Topics