Characteristics Associated with the Choice of First Injectable Therapy Among US Patients With Type 2 Diabetes

Publication date: December 2017
Source:Clinical Therapeutics, Volume 39, Issue 12
Author(s): Maria Yu, Reema Mody, Laura Fernández Landó, Amy Shui, Lee Kallenbach, Lukas Slipski, Carolina Piras de Oliveira
PurposeThe objective of this retrospective observational study was to describe and identify clinical and demographic characteristics associated with the choice of first injectable therapy (glucagon-like peptide-1 receptor agonist [GLP-1-RA] or basal insulin) among patients with type 2 diabetes mellitus (T2DM).MethodsThis analysis included adults naive to injectable therapy with T2DM who initiated a GLP-1-RA or basal insulin (index date) between November 2014 and February 2016 using data from the Practice Fusion Electronic Health Record database. Patients with T2DM, ≥1 office visit between 6 and 18 months before the index date, and with ≥1 glycosylated hemoglobin (HbA1c) result in the 6-month preindex (baseline) period were included. A generalized boosted regression model was used to determine the patient characteristics most influential in the selection of a GLP-1-RA or basal insulin as first injectable therapy. Sensitivity analysis was performed by using bootstrapped logistic regression.FindingsThe study included 3546 and 7507 GLP-1-RA and basal insulin initiators, respectively. At baseline, GLP-1-RA initiators were significantly younger (mean, 58 vs 63 years), had lower HbA1c values (mean, 8.2% vs 9.1%), lower Diabetes Complications Severity Index (DCSI) scores (mean, 1.0 vs 1.7), and a higher body mass index (BMI) (mean, 36 vs 33 kg/m²) compared with basal insulin initiators. Variables selected by using the generalized boosted regression model with the highest relative importance (≥5%) in the selection of GLP-1-RA or basal insulin were HbA1c level (20.43%), BMI (17.73%), age (12.21%), prior prescription of a sodium-glucose cotransporter-2 inhibitor (9.17%), and DCSI score (8.39%). The same variables, as well as race, were selected by using stepwise logistic regression in all the bootstrapped samples. Patients who were older (adjusted odds ratio [OR], 0.975 [95% CI, 0.971–0.979]) and had higher HbA1c values (OR, 0.741 [95% CI, 0.721–0.761]) and DCSI scores (OR, 0.870 [95% CI, 0.848–0.892]) were significantly less likely to be prescribed a GLP-1-RA compared with basal insulin. Patients with higher BMI (OR, 1.046 [95% CI, 1.040–1.053]) and previous prescription of sodium-glucose cotransporter-2 inhibitors (OR, 2.633 [95% CI, 2.224–2.982]) were significantly more likely to be prescribed a GLP-1-RA.ImplicationsThe clinically relevant differences observed between the 2 patient populations suggest that GLP-1-RAs and basal insulin are prescribed to different types of patients with T2DM. Examining patients' demographic and clinical characteristics may be important in assisting physicians in the choice of patient-centered injectable treatment regimens.



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