National Trends in Treatment of Type 2 Diabetes Mellitus, 1994-2007
- 27 October 2008
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 168 (19), 2088-94
- https://doi.org/10.1001/archinte.168.19.2088
Abstract
Diabetes mellitus is common, costly, and increasingly prevalent. Despite innovations in therapy, little is known about patterns and costs of drug treatment. We used the National Disease and Therapeutic Index to analyze medications prescribed between 1994 and 2007 for all US office visits among patients 35 years and older with type 2 diabetes. We used the National Prescription Audit to assess medication costs between 2001 and 2007. The estimated number of patient visits for treated diabetes increased from 25 million (95% confidence interval [CI], 23 million to 27 million) in 1994 to 36 million (95% CI, 34 million to 38 million) by 2007. The mean number of diabetes medications per treated patient increased from 1.14 (95% CI, 1.06-1.22) in 1994 to 1.63 (1.54-1.72) in 2007. Monotherapy declined from 82% (95% CI, 75%-89%) of visits during which a treatment was used in 1994 to 47% (43%-51%) in 2007. Insulin use decreased from 38% of treatment visits in 1994 to a nadir of 25% in 2000 and then increased to 28% in 2007. Sulfonylurea use decreased from 67% of treatment visits in 1994 to 34% in 2007. By 2007, biguanides (54% of treatment visits) and glitazones (thiazolidinediones) (28%) were leading therapeutic classes. Increasing use of glitazones, newer insulins, sitagliptin phosphate, and exenatide largely accounted for recent increases in the mean cost per prescription ($56 in 2001 to $76 in 2007) and aggregate drug expenditures ($6.7 billion in 2001 to $12.5 billion in 2007). Increasingly complex and costly diabetes treatments are being applied to an increasing population. The magnitude of these rapid changes raises concerns about whether these more costly therapies will result in proportionately improved outcomes.Keywords
This publication has 20 references indexed in Scilit:
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Trends in A1C Concentrations Among U.S. Adults With Diagnosed Diabetes From 1999 to 2004Diabetes Care, 2007
- Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular CausesThe New England Journal of Medicine, 2007
- Accuracy of Administrative Coding for Type 2 Diabetes in Children, Adolescents, and Young AdultsDiabetes Care, 2007
- Frequent Outpatient Contact and Decreasing Medication Affordability in Patients With Diabetes From 1997 to 2004Diabetes Care, 2006
- Trends in Complexity of Diabetes Care in the United States From 1991 to 2000Archives of Internal Medicine, 2004
- Economic Costs of Diabetes in the U.S. in 2002Diabetes Care, 2003
- Diabetes trends in the USADiabetes/Metabolism Research and Reviews, 2002
- The underuse of insulin therapy in North AmericaDiabetes/Metabolism Research and Reviews, 2002
- Projection of Diabetes Burden Through 2050Diabetes Care, 2001