Many adults discontinue DPP-IV inhibitor therapy after initiating insulin
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More than half of adults with type 2 diabetes prescribed DPP-IV inhibitor therapy discontinued the medications within 1 year of initiating insulin, according to findings from a U.S. health claims database analysis.
“Among patients treated with metformin and DPP-IV inhibitors who were newly prescribed insulin, 33.3% and 57.3% discontinued DPP-IV inhibitor therapy within 3 and 12 months, respectively,” Gail Fernandes, MPH, director of the Center for Observational and Real-World Evidence (CORE), a department at Merck, told Healio. “Physician characteristics, such as physician specialty, age, sex and location, impacted the reasons for treatment decisions. This highlights the need for enhanced physician training and support as new clinical data emerges and therapy options are available.”
In a retrospective study, Fernandes and colleagues assessed the discontinuation of DPP-IV inhibitor therapy among 3,391 adults with type 2 diabetes prescribed metformin and a DPP-IV inhibitor who initiated insulin. The researchers used information from the Clinformatics Data Mart, a database of administrative health care claims. In a separate cross-sectional survey, the researchers administered an online questionnaire to 406 physicians in the United States to examine reasons for discontinuation. Respondents included endocrinologists (34.5%), general practitioners (32.5%), internal medicine specialists (30.5%) and diabetologists (2.5%), treating a monthly average of 154 patients.
Among patients treated with metformin and DPP-IV inhibitors who were newly prescribed insulin, 33.3% and 57.3% discontinued DPP-IV inhibitor therapy within 3 and 12 months, respectively. Compared with adults who continued with DPP-IV inhibitor therapy, a higher proportion of those who discontinued therapy were Medicare members (34% vs. 30.5%; P = .03) and were more likely to have chronic renal disease (8.7% vs. 5.5%; P < .01) and liver disease (8.9% vs. 6.8%; P = .03).
“Higher pre-index health care resource utilization, with more frequent physician visits (P = .02), a higher number of hospitalizations (P < .01) and a longer length of stay (P < .01) were observed for patients who discontinued DPP-IV inhibitors,” the researchers wrote. “Out-of-pocket costs at index date were also significantly higher for those patients who discontinued the DPP-IV inhibitor therapy compared to those who continued use (P < .01).”
The top three physician responses for discontinuation were adverse events or tolerability issues (58.9%), lack of efficacy or treatment goals not being met (55.4%) and the additional cost of DPP-IV inhibitor therapy with insulin (48.5%). The top three responses for continuing DPP-IV inhibitor therapy were meeting treatment goals (70.7%), using a lower dose of insulin (65.3%) and good tolerability (48%).
Physician characteristics, such as physician specialty, age, sex and location influenced reasons for treatment decisions, according to researchers.
“Clinical data suggests that continuation of DPP-IV inhibitor therapy after the initiation of insulin therapy can provide greater blood glucose reductions and help more patients reach HbA1c goals compared with those who discontinue,” Fernandes said. “Despite this, a high proportion of patients in the real world discontinue DPP-IV inhibitor therapy when initiating insulin. This study identifies physician characteristics associated with treatment decision and may help inform physician practices.” – by Regina Schaffer
For more information:
Gail Fernandes, MPH, can be reached at Merck, 351 N. Sumneytown Pike, 2MW05, North Wales, PA 19454; email: gail.fernandes@merck.com.
Disclosures: Merck funded this study and approved the submitted manuscript. Fernandes reports she is an employee of Merck. Please see the study for all other authors’ relevant financial disclosures.
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