Increased Persistency in Medication Use by U.S. Medicare Beneficiaries With Diabetes Is Associated With Lower Hospitalization Rates and Cost Savings

Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, Maryland, USA.
Diabetes care (Impact Factor: 8.42). 02/2009; 32(4):647-9. DOI: 10.2337/dc08-1311
Source: PubMed


To assess the relationship between annual fills for antidiabetes medications, ACE inhibitors, angiotensin II receptor blockers (ARBs), and lipid-lowering agents on hospitalization and Medicare spending for beneficiaries with diabetes.
Using Medicare Current Beneficiary Survey data from 1997 to 2004, we identified 7,441 community-dwelling beneficiaries with diabetes, who contributed 14,317 person-years of data for the analysis. We used multivariate regression analysis to estimate the effect of persistency in medication fills on hospitalization risk, hospital days, and Medicare spending.
For users of older oral antidiabetes agents, ACE inhibitors, ARBs, and statins, each additional prescription fill was associated with significantly lower risk of hospitalization, fewer hospital days, and lower Medicare spending.
These results suggest an economic case for promoting greater persistency in use of drugs with approved indications by Medicare beneficiaries with diabetes; however, additional research is needed to corroborate the study's cross-sectional findings.

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Available from: Linda Simoni-Wastila, Oct 07, 2014
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    • "due to hospitalizations, temporary or permanent disability because of diabetes related complications) [7]. Stuart et al. reported a positive relationship between persistency to glucose lowering medication and decreased healthcare costs and lower hospitalization rates [8]. "
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    ABSTRACT: Type 2 diabetes is a common and costly illness, associated with significant morbidity and mortality. Despite this, there is relatively little information on the 'real-world' medication utilization patterns for patients with type 2 diabetes initiating exenatide BID or glargine. The objective of this study was to evaluate the 'real-world' medication utilization patterns in patients with type 2 diabetes treated with exenatide BID (exenatide) versus insulin glargine (glargine). Adult patients( >=18 years of age) with type 2 diabetes who were new initiators of exenatide or glargine from October 1, 2006 through March 31, 2008 with continuous enrollment for the 12 months pre- and 18 months post-index period were selected from the MarketScan(R) Commercial and Medicare Databases. To control for selection bias, propensity score matching was used to complete a 1:1 match of glargine to exenatide patients. Key study outcomes (including the likelihood of overall treatment modification, discontinuation, switching, or intensification) were analyzed using survival analysis. A total of 9,197 exenatide- and 4,499 glargine-treated patients were selected. Propensity score matching resulted in 3,774 matched pairs with a mean age of 57 years and a mean Deyo Charlson Comorbidity Index score of 1.6; 54% of patients were males. The 18-month treatment intensification rates were 15.9% and 26.0% (p < 0.0001) and the discontinuation rates were 38.3% and 40.0% (p = 0.14) for exenatide and glargine, respectively. Alternatively, 14.9% of exenatide-treated patients switched therapies, compared to 10.0% of glargine-treated patients (p < 0.0001). Overall, glargine-treated patients were more likely to modify their treatment [hazard ratio (HR) = 1.33, p < 0.0001] with shorter mean time on treatment until modification (123 vs. 159 days, p < 0.0001). Compared to exenatide-treated patients, glargine-treated patients were more likely to discontinue [hazard ratio (HR) = 1.25, p < 0.0001] or intensify therapy (HR = 1.72, p < 0.0001) but less likely to switch (HR = 0.71, p < 0.0001) the index therapy. Patients treated for type 2 diabetes with exenatide BID or insulin glargine differ in their adherence to therapy. Exenatide-treated patients were less likely to discontinue or modify treatment but more likely to switch therapy compared to glargine-treated patients.
    Full-text · Article · Jun 2013 · BMC Endocrine Disorders
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    • "Inadequate self-management of medical conditions, including not taking medications as prescribed, may contribute to the compromised health status of these patients. Studies in the general population with Type 2 diabetes have shown that poor adherence to hypoglycemic medications is associated with numerous adverse health consequences, including inadequate control of blood glucose (Schectman et al., 2002; Krapek et al., 2004; Ho et al., 2006; Rozenfeld et al., 2008), increased hospitalizations (Lau and Nau, 2004), increased healthcare costs (Sokol et al., 2005; Stuart et al., 2009), and possibly increased mortality (Ho et al., 2006). Although a large body of research has demonstrated that individuals with schizophrenia have difficulties adhering to antipsychotic medications (see reviews; Lacro et al., 2002; Byerly et al., 2007a) many fewer studies (Dolder et al., 2003; Dolder et al., 2005; Piette et al., 2007; Kreyenbuhl et al., 2010) have investigated whether adherence to medications for chronic medical conditions is similarly problematic, and no studies have examined whether nonadherence is associated with poor medical outcomes in these patients. "
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    ABSTRACT: Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes.
    Full-text · Article · Apr 2011 · Psychiatry Research
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    • "Improvements in the quality of primary care for diabetes were reflected by a decrease in diabetes-related preventable hospitalizations [4]. Factors that may have contributed to the decline in diabetes-related preventable hospitalizations include early detection of diabetes [5], annual screening for complications [6] [7], multifactorial intervention using medications with approved indications [8], education classes [9], and immunizations against the commonest respiratory infections [10]. Diabetes in Kuwait is a major public health problem. "
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    ABSTRACT: Background A large proportion of hospitalizations for diabetes are preventable. We carried out this study to determine the prevalence and reasons for hospitalization in adults with diabetes in Kuwait. Materials and methods A cross-sectional study was conducted of all hospital admissions in the Department of Medicine at Al-Sabah Hospital in Kuwait during a 2-month period. Admissions were classified into three groups: (i) medical history of diabetes; (ii) unrecognized diabetes or new hyperglycemia (i.e., an admission for fasting blood glucose ≥34;7 mmol/l or random blood glucose ≥34;11.1 mmol/l); and (iii) no diabetes. Results Diabetes was the principal or secondary diagnosis in 40.6% of hospitalizations. Unrecognized diabetes or new hyperglycemia was found in 12.9% of the patients. Patients with diabetes or new hyperglycemia were significantly older and had longer hospital stay compared to non-diabetic patients. The three most common reasons for hospitalizations in patients with diabetes were diseases of the cardiovascular system (53.6%), diseases of the respiratory system (22.8%), and diabetes as a principal diagnosis (6.3%). The five most frequent specific causes for hospitalizations in patients with medical history of diabetes as a secondary diagnosis were acute coronary syndrome (27.2%), pneumonia (14.3%), heart failure (11.2%), cerebrovascular accident (10.3%), and chronic obstructive airway disease (3.6%). Conclusion Diabetes imposes a great burden on secondary health care in Kuwait. Effective primary care and hospital outpatient preventive and treatment strategies, including education, multifactorial intervention for cardiovascular risk factors, and influenza and pneumococcal immunizations for patients with diabetes may reduce these hospitalizations among diabetic patients.
    Full-text · Article · Feb 2011 · International Journal of Diabetes Mellitus
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