Trends in Diabetes Treatment and Monitoring among Medicare Beneficiaries
Diabetes is a costly and common condition, but little is known about recent trends in diabetes management among Medicare beneficiaries.
To evaluate the use of diabetes medications and testing supplies among Medicare beneficiaries.
Retrospective cohort analysis of Medicare claims from 2007 to 2014.
Traditional Medicare beneficiaries with a diagnosis of diabetes in the current or any prior year.
We analyzed choices of first diabetes medication for those new to medication and patterns of adding medications. We also examined the use of testing supplies, use of statins and ACE inhibitors/angiotensin receptor blockers, and spending.
Diagnosed diabetes increased from 28.7% to 30.2% of beneficiaries from 2007 to 2014. The use of metformin as the most commonly prescribed first medication increased from 50.2% in 2007 to 70.2% in 2014, whereas long-acting sulfonylureas decreased from 16.6% to 8.2%. The use of thiazolidinediones fell considerably, while the use of new diabetes medication classes increased. Among patients prescribed insulin, long-acting insulin as the first choice increased substantially, from 38.9% to 56.8%, but short-acting or combination regimens remained common, particularly among older or sicker beneficiaries. Prescriptions of testing supplies for more than once-daily testing were also common. The mean total cost of diabetes medications per patient increased over the period due to the increasing use of high-cost drugs, particularly by those patients with costs above the 90th percentile of spending, although the median costs decreased for both medications and testing supplies.
The use of metformin and long-acting insulin have increased substantially among elderly Medicare patients with diabetes, but a substantial subgroup continues to receive costly and complex treatment regimens.
KEY WORDSMedicare elderly diabetes
This work was supported by a grant from the National Institute on Aging (P01 AG032952, J. Newhouse, PI).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2014.Google Scholar
- 3.Centers for Disease Control and Prevention. Mean and Median Age at Diagnosis of Diabetes Among Adult Incident Cases Aged 18-79 Years, United States, 1997-2011. Atlanta, GA: US Department of Health and Human Services; 2015. https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed Jan 25 2018.Google Scholar
- 4.Chronic Conditions Data Warehouse. Medicare – CCW Condition Period Prevalence, 2014. 2016.Google Scholar
- 5.Reusch JE, Manson JE. Management of type 2 diabetes in 2017: getting to goal. JAMA. 2017;317(10)1015–6. https://doi.org/10.1001/jama.2017.0241.
- 6.Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-934.CrossRefPubMedGoogle Scholar
- 7.American Diabetes Association. Standards of medical care in diabetes-2016: Summary of revisions. Diabetes Care. 2016;39(Suppl 1):S4–5.Google Scholar
- 10.https://www.idf.org/e-library/guidelines/78-global-guideline-for-managing-older-people-withtype-2-diabetes.html 2013. Accessed Jan 25 2018.
- 13.American Diabetes Assocation. 10. Older Adults. Diabetes care. 2015;38(Suppl 1):S67-S9.Google Scholar
- 16.Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, Leiter LA, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375:1834-1844.Google Scholar
- 23.Margolis DJ, Leonard CE, Razzaghi H, Hoffstad OJ, Freeman CP, de Nava KL, et al. Utilization of antidiabetic drugs among Medicare beneficiaries with diabetes, 2006-2009: Data Points #9. 2012. https://www.ncbi.nlm.nih.gov/books/NBK92702/#dp9.s1. Accessed Jan 25 2018.
- 27.Centers for Medicare and Medicaid Services. Chronic Conditions Data Warehouse.Google Scholar
- 28.Centers for Medicare and Medicaid Services DoHaHS. Chronic Conditions Data Warehouse home page. https://www.ccwdata.org/web/guest/home. Accessed Jan 25 2018.
- 29.Approaches to Glycemic Treatment. Diabetes Care. 2016;39(Suppl 1):S52–S9.Google Scholar
- 31.American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–46. https://doi.org/10.1111/jgs.13702. Accessed Jan 25 2018.
- 32.American Diabetes Association. New Standards of Care Provide Guidelines for Statin Use for People with Diabetes to Prevent Heart Disease. 2014. http://www.diabetes.org/newsroom/press-releases/2014/new-standards-of-care-provide-guidelines-forstatin-use-for-people-with-diabetes-to-prevent-heart-disease.html?referrer=https://www.google.com/. Accessed Jan 25 2018.
- 34.Bonito A, Bann C, Eicheldinger C, Carpenter L. Creation of New Race-Ethnicity Codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries Final Report. 2008. https://archive.ahrq.gov/research/findings/final-reports/medicareindicators/. Accessed Jan 25 2018.
- 38.Perry Undem Research/Communication. Unnecessary Tests and Procedures In the Health Care System. ABIM; 2014. http://www.choosingwisely.org/wp-content/uploads/2015/04/Final-Choosing-Wisely-Survey-Report.pdf. Accessed Jan 25 2018.
- 50.Gomes T, Martins D, Tadrous M, Paterson JM, Shah BR, Tu JV, et al. Association of a Blood Glucose Test Strip Quantity-Limit Policy With Patient Outcomes: A Population-Based Study. JAMA Intern Med. 2016;77(1):61-66.Google Scholar
- 52.Centers for Medicare and Medicaid Services. Department of Health and Human Services. Contract suppliers selected under medicare competitive bidding program. 2013. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-04-092.html. Accessed Jan 25 2018.
- 54.Sussman JB, Kerr EA, Saini SD, Holleman RG, Klamerus ML, Min LC, et al. Rates of deintensification of blood pressure and glycemic medication treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA Intern Med. 2015;175(12):1942-9.CrossRefPubMedGoogle Scholar