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首页> 外文期刊>Endocrinology, Diabetes & Metabolism >Compared to commercially insured patients, Medicare advantage patients adopt newer diabetes drugs more slowly and adhere to them less
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Compared to commercially insured patients, Medicare advantage patients adopt newer diabetes drugs more slowly and adhere to them less

机译：与商业上投保患者相比，Medicare Advantage患者更慢地采用更新的糖尿病药物，并依附于它们

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Aims To compare rates of use and adherence for newer versus older second-line diabetes drug classes in commercially insured, Medicare Advantage and dual-eligible (covered by both Medicare and Medicaid) patients. Materials and Methods Longitudinal cohort study using insurance claims data from 1/1/2012 to 12/31/2016 to identify patients with a first prescription, after metformin, of a second-line diabetes drug (eg sulphonylurea, DPP-4 inhibitor, thiazolidinedione, SGLT-2 inhibitor or GLP-1 receptor agonist) and to estimate their adherence to that drug class. Univariate analysis and multivariable logistic regression were used to examine the association between insurance type and use of each drug class, and between insurance type and adherence to each drug class. Results The study population included 96,663 patients. Trends in drug use differed by insurance type. For example, sulphonylurea use declined among the commercially insured (from 46% to 39%, p ?.001) but not among Medicare Advantage or dual-eligible patients. Patterns of adherence also differed between insurance groups. For example, compared to commercial insurance, Medicare Advantage was associated with higher adherence to sulphonylurea (odds ratio [OR] 1.32, 95% CI 1.21–1.43)) but lower adherence to SGLT-2 inhibitors (OR 0.43 (95% CI 0.33–0.56)). Conclusions This study finds differences in utilization and adherence for diabetes drugs across insurance types. Older medications such as sulphonylureas appear to be more used and better adhered to among Medicare Advantage recipients, while the opposite is true for newer medication classes. These findings suggest a need to personalize selection of diabetes drugs according to insurance status, particularly when adherence needs optimization.
机译：旨在比较商业保险，医疗保险优势和双重符合条件（医疗保险和医疗补助）患者的使用率和较新的二线糖尿病药物课程的使用和遵守率。材料和方法纵向队列使用保险权利要求的研究从1/1/1212-2016到12/31/2016，以鉴定二线糖尿病药物后第一个处方（例如磺酰脲，DPP-4抑制剂，噻唑烷基，SGLT-2抑制剂或GLP-1受体激动剂）并估计它们对该药物课程的依从性。单变量分析和多变量逻辑回归用于检查保险类型与每个药物课程之间的关联，以及保险类型与每个药物课程之间的依从性。结果研究人群包括96,663名患者。药物使用的趋势受保险类型不同。例如，在商业上保险（46％至39％，P＆ 001）中，磺酰脲类使用下降，但不包括医疗保险优势或双合格患者。遵守模式也有不同的保险团体。例如，与商业保险相比，医疗保险优势与抑制于磺酰脲的粘附较高有关（差距[或] 1.32,95％CI 1.21-1.43），而是降低对SGLT-2抑制剂的粘附（或0.43（95％CI 0.33- 0.56）））。结论本研究发现，在保险类型中发现糖尿病药物的利用和依从性差异。诸如磺酰脲类如少年的药物似乎更常用，更好地粘附在Medicare Advantage受体中，而对新药类的相反是正确的。这些研究结果表明，根据保险状况，需要个性化糖尿病药物的选择，特别是当遵守需要优化时。

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