Patterns of medication initiation in newly diagnosed diabetes mellitus: quality and cost implications.

Currently, 25 million Americans are known to have diabetes, with an additional 7 million cases believed to be undiagnosed. It is estimated that direct and indirect costs of diabetes top $200 billion. Due to the significant health and financial burdens associated with diabetes, it is imperative that this disease be treated quickly and aggressively. In 2009, the American Diabetes Association and the European Association for the Study of Diabetes developed a consensus statement regarding the treatment of type 2 diabetes, citing lifestyle modification and metformin as the preferred first line therapies. In this study, the authors looked at prescription claims data for adults who were newly initiated on oral hypoglycemic monotherapy between January 1, 2006, and December 31, 2008, to determine if initiation patterns changed over time, to evaluate how well the treatment guidelines were being followed, and to assess the economic consequences of prescribing patterns by drug class for both patients and insurers. The results showed that over the course of the study period the proportion of patients initially treated with metformin increased, whereas those receiving sulfonylureas as first-line therapy decreased. Thiazolidinediones experienced the greatest decrease, falling from 20% to 8%, while prescriptions for dipeptidyl peptidase-4 inhibitors increase from 0-7%. Over a 6-month period, patients taking metformin or sulfonylureas paid approximately $38 to $40 in co-pays while insurance paid about $77. Patients taking other agents paid approximately $130 in co-pays and insurance paid over $500. The authors concluded that based its cost and safety profile, metformin should be the first line drug therapy for patients with newly diagnosed type 2 diabetes. This CME multimedia activity, which is part of a 2-part multimedia activity on the management and treatment of diabetes, contains a video presentation and is available through the website of The American Journal of Medicine at http://amjmed.com/content/multimedia. Click on "Patterns of Medication Initiation in Newly Diagnosed Diabetes Mellitus: Quality and Cost Implications" to access this part of the multimedia program.

Management of type 2 diabetes: new and future developments in treatment.

To date, six classes of oral medication have been approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes and several new agents are in the pipeline. In 2009, the American Diabetes Association and the European Association for the Study of Diabetes developed a consensus statement regarding the treatment of type 2 diabetes, citing lifestyle modification and metformin as the preferred first line therapies. In addition to the currently available drugs, several new agents have recently been introduced or are in the development pipeline. Incretin therapies include both glucagon-like peptide-1 (GLP-1) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors. Non-incretin beta cell stimulants still in development include glucokinase activators, G-protein-coupled receptors, and anti-inflammatory and anti-oxidant therapies. Additional agents that target glucose synthesis include glucose-6-phosphatase and glycogen phosphorylase. Other new agents target metabolic syndrome, which is often the first clinical condition that presents in patients at risk for type 2 diabetes. Finally, for obese patients who are unable to lose weight through diet and exercise, weight-loss surgery is an option that should be discussed with their physicians. This CME multimedia activity, which is part of a 2-part multimedia activity on the management and treatment of diabetes, contains a video presentation and is available through the website of The American Journal of Medicine at http://amjmed.com/content/multimedia. Click on "Management of Type 2 Diabetes: New and Future Developments in Treatment" to access this part of this multimedia program.