Journal
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY
Volume 21, Issue 9, Pages 920-928Publisher
WILEY
DOI: 10.1002/pds.2262
Keywords
Type 2 Diabetes Mellitus; Pharmacoepidemiology; Electronic Health Records; Oral hypoglycemics
Funding
- UNC-GSK Center for Excellence in Pharmacoepidemiology and Public Health at the University of North Carolina, Gillings School of Global Public Health
- Novartis
- (RTI International DEcIDE Center) from the Agency for Healthcare Research and Quality, US Department of Health and Human Services [HHSA29020050036I]
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Background Diabetes is a leading cause of death and disability, and its prevalence is increasing. When diet fails, patients with type 2 diabetes mellitus (T2DM) are prescribed oral hypoglycemics for glycemic control. Few studies have explored initial use or change from initial oral hypoglycemic therapy in the primary care setting. We aimed to describe the utilization of initial oral hypoglycemics among newly diagnosed patients with diabetes from 19982009 and changes from initial to subsequent therapy among patients prescribed older oral hypoglycemic agents using electronic health records. Methods This observational cohort study used electronic health records from newly diagnosed patients with T2DM between 1 January 1998 and 31 March 2009 at two large health systems in the USA. Oral hypoglycemics included older (biguanide, sulfonylurea, and thiazolidinedione) and newer agents (incretin mimetic agents, alpha-glucosidase inhibitors, and D-phenylalanine derivatives). Multinomial regression models were fit to evaluate initial older oral hypoglycemic medication. We used incidence density sampling and conditional logistic regression models to evaluate predictors of regimen change. Results Most patients were treated from the biguanide class of oral hypoglycemics (67%), but there were differences in initial prescribing by age and race. HbA1c (Odds Ratio for HbA1c 7.08.9 vs
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