Time to initiation of oral antihyperglycemic and statin therapy in previously untreated patients with type 2 diabetes in the United States

Abstract

Objective:

To assess the time from the first observed diagnosis of type 2 diabetes (T2DM) to initiation of an oral antihyperglycemic agent (OAHA) and statin.

Methods:

In a retrospective US cohort study using the GE electronic medical record database, patients ≥18 years were included if they had a T2DM diagnosis between January 1, 2004 and December 31, 2005 (index period), had a last pre-index HbA_1c value ≥7%, and had not received antihyperglycemic agents within one year prior to diagnosis (index date). Patients were eligible for statin therapy but not on a statin within one year before the index date. Patients had medical records for one year prior to (baseline) and two years after (follow up) diagnosis.

Results:

Of the 2254 eligible patients, 58% were male, mean age was 58 years, mean HbA_1c was 8.5%, and mean LDL cholesterol was 115 mg/dL (2.97 mmol/L) at baseline. Additionally, 21% of patients had pre-existing overt cardiovascular disease, 40% had dyslipidemia, 37% were obese, and 11% were smokers. During follow-up, 66.1% and 41.9% of patients initiated an OAHA and a statin, respectively. Among the treated patients, median time from the first observed diabetes diagnosis to therapy initiation was 3 months (interquartile range: 1, 9) for OAHAs and 6 months (2, 13) for statins.

Limitations:

Treatment initiation with injectable antihyperglycemic agents and/or non-statin lipid-modifying therapies as well as contraindications to OAHAs or statins were not assessed, therefore their impact on our study results cannot be determined. Laboratory measurements were not available for every patient and thus many patients were excluded from the analysis.

Conclusion:

Treatment initiation with OAHAs and/or statins was suboptimal in patients with T2DM who were treatment eligible and previously untreated with OAHAs and statins. Of those treated, patients initiated treatment with an OAHA more often and earlier than with a statin.

Keywords::

• Oral antihyperglycemic agents
• Statins
• Type 2 diabetes
• Undertreatment

Transparency

Declaration of funding

Analyses described in this manuscript were funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Whitehouse Station, NJ, USA.

All authors were involved in the concept and design of the study and in the data collection and/or analysis. All authors were involved in interpretation of the results. M.J.D. drafted the article and all authors were involved in the critical revisions, discussions, and approval of the article.

Declaration of financial/other relationships

K.T., Q.Z., T.S., K.I., M.J.D., B.A., and L.R. are employed or were employed at the time of the analysis by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, and may have stock or stock options in the company. P.S. has disclosed that he or his employer have received grants/research support from Merck Sharp & Dohme Corp., Abbott Laboratories, Pfizer Inc, Eli Lilly and Company, Novartis, and other major pharmaceutical companies.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.