How to make diabetes control easier for patients


A real-world study of type 2 diabetes patients by Milliman has surprising findings on glycemic control and diabetes medication adherence.

New research uses real-world administrative data from commercial payers and patient clinical data to find correlations between patients with type 2 diabetes.

The study was conducted by Milliman, a management consultant group, and presented at the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2017. The authors looked at data from 2012 to 2014 from patients in three different cohorts who had type 2 diabetes.

“Our results are consistent with findings in the literature that better diabetes medication adherence is correlated with better hemoglobin A1c control, and that hemoglobin A1c and diabetes medication adherence among commercially insured patients is suboptimal,” the study’s authors found. “These findings highlight the need for evaluating medications and systems of care from the standpoint of real-world hemoglobin A1c control and health outcomes.”

The consultant group used the Truven Health MarketScan Research database to evaluate claims data from about 100 payers. The MarketScan laboratory database was used to evaluate hemoglobic A1c laboratory data. The Medi-Span database was also used to identify diabetes drugs usage.

One cohort included nearly 4,000 patients who had at least one hemoglobin A1c (HbA1c) test each year. Both glycemic control and diabetes medication adherence was difficult for patients to sustain. The researchers found that only 24% of patients were able to sustain hemoglobin A1c less than 7% for all three years. Only 18% of patients were able to consistently take medications for all three years.

The second cohort provided a one-year snapshot of more than 36,000 patients. The researchers found that patients with poor glycemic control have higher healthcare costs than those who had controlled glycemic levels.

The third cohort included almost 80,000 patients in a six-month period of time who had a hemoglobin A1c episode. Complexity of diabetes treatment regimen made medication adherence more difficult for patients. “Adherence was exhibited in 53% of hemoglobin A1c episodes during oral-only drug therapy verses 43% with injectable-only therapy and 40% with combined oral and injectable therapy,” the researchers said.

Ultimately, patients that have issues with medication adherence had higher HbA1c levels, which led to higher healthcare costs. “These findings highlight the need for evaluating the financial and population health outcomes of diabetes medications and delivery systems that can improve adherence and HbA1c control, the authors said.

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