Ambulatory treatment of type 2 diabetes in the U.S., 1997-2012


Turner LW, Nartey D, Stafford RS, Singh S, Alexander GC. Ambulatory treatment of type 2 diabetes in the U.S., 1997-2012. Diabetes Care. 2014;37:985-992. 


An analysis examined trends in type 2 diabetes treatment among office-based physicians in the United States from 1997 to 2012. Between 1997 and 2007, there was a steady increase in type 2 diabetes treatment visits, peaking at 35.3 million visits in 2007, and declining to 31.2 million visits in 2012.
  

Commentary Thumb Fonseca T2D Trends 

Diabetes treatments, by medication class:

  • Sulfonylureas: more than half of all visits in 1997 (61%) with continuous decline since; 22% of visits in 2012 
  • Glitazones: increase from 1997 to 2005; 6% of visits in 1997; peak: 41% in 2005; 16% of visits in 2012 (~96% of visits involved pioglitazone products)
  • Biguanide (metformin): Steady increase; 24% of visits in 1997; 53% of visits in 2012
  • DPP-4 inhibitors: 21% of visits since FDA approved in 2006
  • GLP-1 agonists: 4% of visits since FDA approved in 2010
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US Trends in Type 2 Diabetes Treatment 1997-2012 Medication Classes   
US Trends in Type 2 Diabetes Treatment,
1997-2012: Medication Classes
 

 Stable insulin use was seen from 1997 to 2012 (27% vs 26%, respectively); however, when visits were examined by insulin type:

  • Regular: 2% of visits since 1997
  • NPH: 3% of visits since 1997
  • Short-acting: doubled in use from 1997 to 2012
  • Long-acting: <1% of visits in 1997 to ~18% in 2012
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US Trends in Type 2 Diabetes Treatment 1997-2012 Insulin Use 
US Trends in Type 2 Diabetes Treatment,
1997-2012: Insulin Use
  

A decline in visits where a single treatment (including fixed-dose combination therapy) was used was seen between 1997 and 2012 (59.5% and 41.7% of visits, respectively). The same was true for visits where a single compound was used (54.2% in 1997 and 35.1% in 2012). Visits where more than two treatments were prescribed increased from 40.5% of visits in 1997 to 58.3% in 2012. 

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US Trends in Diabetes Treatment 1997-2012 Number of Treatments   
US Trends in Type 2 Diabetes Treatment,
1997-2012: Number of Treatments 
 

There were 14.9 million treatment visits in 2012 in which a single compound was used. Visits where a single compound was used declined from 54% of visits in 1997 to 35% in 2012. A decline in visits where a single treatment was used was also seen: 60% in 1997 to 42% in 2012. Biguanides were being used in over half of visits (53%) where a single compound was used. Insulins were the second most-used compound (15%).

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US Trends in Type 2 Diabetes Treatment 1997-2012 Type of Treatment Used Visit with 1 Compound in 2012    
US Trends in Type 2 Diabetes Treatment,
1997-2012: Type of Treatment Used,
Visit with 1 Compound in 2012
 

There were 18.2 million treatment visits in 2012 in which two or more compounds were used. Visits were two more compounds were used increased from 41% in 1997 to 58% in 2012. Biguanides + sulfonylureas were being used in nearly one-third of visits (31%) where two or more compounds were being used, and biguanides and DPP-4 inhibitors being used in 20%, or approximately one-fifth, of visits. 

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US Trends in Diabetes Treatment 1997-2012 Type of Treatment Used Visit with 2 plus Compounds in 2012    
US Trends in Type 2 Diabetes Treatment,
1997-2012: Type of Treatment Used,
Visit with 2+ Compounds in 2012
  

About this study
Data were from the IMS Health National Disease and Therapeutic Index and the IMS Health National Prescription Audit. Persons aged ≥35 years with a “treatment visit” at which one or more antihyperglycemic agents was used for treatment of type 2 diabetes were included in the analysis. Each product dispensed equates to a separate treatment visit. 

Percentages shown are % of treatment visits where medication classes were prescribed. 

  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

May 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 8/4/2014