Patient and prescriber characteristics among patients with type 2 diabetes mellitus continuing or discontinuing sulfonylureas following insulin initiation: data from a large commercial database

Abstract

Objective: To describe patient and provider characteristics for patients with type 2 diabetes (T2DM) initiating basal insulin and describe basal insulin’s impact on sulfonylurea (SU) discontinuation.

Methods: A retrospective cohort study was conducted using the HealthCore Integrated Research Database. Patients had ≥12 months of continuous coverage prior to initiating insulin, and were utilizing at least one anti-hyperglycemic drug at the time of insulin initiation. Predictors for SU discontinuation were evaluated utilizing Cox proportional hazards models.

Results: Among the 74,334 individuals aged ≥18 years with T2DM who initiated basal insulin from 2006–2015, 30% were taking metformin (MET) and SU when initiating insulin. Among the 22,418 MET/SU patients, 31% discontinued SU within 3 months of insulin initiation and, by 12 months, 55% had discontinued SU. Sulfonylurea discontinuation was similar among many patient and provider characteristics, while being modestly positively associated (p < .05; HRs <1.5) with female gender, more co-morbidities, cardiac revascularization, chronic liver disease, hospitalizations with a T2DM diagnosis, and hypoglycemia prior to insulin initiation. SU discontinuation was modestly inversely associated with receiving an insulin prescription from an endocrinologist (HR = 0.90, 95% CI = 0.85–0.95).

Conclusions: Roughly half of commercially-insured T2DM patients discontinued SU within 1 year after insulin initiation, and SU discontinuation was not strongly associated with a range of patient and provider characteristics.

Keywords:

• Insulin
• SU
• epidemiology
• hypoglycemia

Transparency

Declaration of funding

This study was funded by Merck & Co., Inc., Kenilworth, NJ, USA.

Declaration of financial/other relationships

DCB and GD are employees of HealthCore Inc., an organization whose activities of this study were funded by Merck & Co., Inc. JJ and J. Lyons were employees of HealthCore Inc. when this manuscript was developed. J. Lin was an employee of Merck & Co. when this manuscript was developed and is now an employee of J&J. SL declares research funding from Merck & Co. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge Ramya Avula for programming, Scott Quinlan for participation in the design of the study, and Carrie Levin for review of the manuscript