Recent Trends in Sitagliptin Prescribing
This study utilised a large US employment-based claims database [Clinformatics DataMart, OptumInsight (previously known as i3 InVisionData Mart; Ingenix, Inc., Bethlehem, PA)]. The database includes more than 36 million lives spanning almost 6 years, with more than 11 million patients continuously enrolled for at least 12 months. The database contains longitudinal patient data that includes registration, inpatient and outpatient visits, drug dispensing and lab results. Every billable encounter (e.g. a laboratory test, doctor visit, radiograph or an immunisation) generates a medical services claim, with a coded description of the service rendered, the diagnoses that led to the service, the location, the provider, the patient and the date of service. Laboratory data include laboratory test type and test results.
Patients with T2DM receiving a new prescription for OAHAs from 1 January 2006 to 31 April 2010 and who were between 25 and 64 years of age were identified. Patients were identified as having T2DM by meeting any one of the following criteria: (i) At least one inpatient admission for which the principal diagnosis was recorded as diabetes; (ii) At least one inpatient admission for which any diagnosis was recorded as diabetes coupled with another criterion (OHA prescription, inpatient or outpatient type 2 diabetes diagnosis or laboratory result); (iii) At least two outpatient facility or physician office visit claims for which a diagnosis was recorded as diabetes; (iv) At least one inpatient or outpatient claim of diabetes AND at least one prescription of oral antihyperglycaemic medications or (v) At least one laboratory result of blood glucose> 200 mg/dl OR HbA1C > 6.5%. Patients were included in the analysis if they had at least 12 months of continuous enrolment in the database prior to new prescription. Patients were excluded from the analysis if they were diagnosed with type 1 diabetes, juvenile diabetes, ketoacidosis, malnutrition-associated diabetes, drug-induced diabetes or gestational diabetes at any time in the database without subsequent type 2 diabetes diagnosis code. Patients on injectable diabetes medications were also excluded.
Demographics and baseline comorbidities in the population by ICD-9 codes were determined in the 12-month period before the index date (the time of initial oral antihyperglycaemic prescription). Type of oral treatment regimen was categorised as 1, 2, or ≥ 3 oral medications for hyperglycaemia. Patients with ≥ 12 months of history in the database with no T2DM claims before the index T2DM diagnosis were considered as newly diagnosed patients.
For each dataset (patients receiving a new prescription during 2006–2007, and patients receiving a new prescription during 2008–2010), adjusted odds ratios (OR) with 95% confidence intervals were calculated using multivariate logistic regression analyses adjusting for age, gender, oral treatment type (monotherapy, dual or triple therapy), new or prior T2D diagnosis, and comorbidities and diabetes-related complications in the prior 12 months.
Methods
Data Source
This study utilised a large US employment-based claims database [Clinformatics DataMart, OptumInsight (previously known as i3 InVisionData Mart; Ingenix, Inc., Bethlehem, PA)]. The database includes more than 36 million lives spanning almost 6 years, with more than 11 million patients continuously enrolled for at least 12 months. The database contains longitudinal patient data that includes registration, inpatient and outpatient visits, drug dispensing and lab results. Every billable encounter (e.g. a laboratory test, doctor visit, radiograph or an immunisation) generates a medical services claim, with a coded description of the service rendered, the diagnoses that led to the service, the location, the provider, the patient and the date of service. Laboratory data include laboratory test type and test results.
Study Population
Patients with T2DM receiving a new prescription for OAHAs from 1 January 2006 to 31 April 2010 and who were between 25 and 64 years of age were identified. Patients were identified as having T2DM by meeting any one of the following criteria: (i) At least one inpatient admission for which the principal diagnosis was recorded as diabetes; (ii) At least one inpatient admission for which any diagnosis was recorded as diabetes coupled with another criterion (OHA prescription, inpatient or outpatient type 2 diabetes diagnosis or laboratory result); (iii) At least two outpatient facility or physician office visit claims for which a diagnosis was recorded as diabetes; (iv) At least one inpatient or outpatient claim of diabetes AND at least one prescription of oral antihyperglycaemic medications or (v) At least one laboratory result of blood glucose> 200 mg/dl OR HbA1C > 6.5%. Patients were included in the analysis if they had at least 12 months of continuous enrolment in the database prior to new prescription. Patients were excluded from the analysis if they were diagnosed with type 1 diabetes, juvenile diabetes, ketoacidosis, malnutrition-associated diabetes, drug-induced diabetes or gestational diabetes at any time in the database without subsequent type 2 diabetes diagnosis code. Patients on injectable diabetes medications were also excluded.
Demographics and baseline comorbidities in the population by ICD-9 codes were determined in the 12-month period before the index date (the time of initial oral antihyperglycaemic prescription). Type of oral treatment regimen was categorised as 1, 2, or ≥ 3 oral medications for hyperglycaemia. Patients with ≥ 12 months of history in the database with no T2DM claims before the index T2DM diagnosis were considered as newly diagnosed patients.
Analysis
For each dataset (patients receiving a new prescription during 2006–2007, and patients receiving a new prescription during 2008–2010), adjusted odds ratios (OR) with 95% confidence intervals were calculated using multivariate logistic regression analyses adjusting for age, gender, oral treatment type (monotherapy, dual or triple therapy), new or prior T2D diagnosis, and comorbidities and diabetes-related complications in the prior 12 months.
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