The Impact of ADA Guideline Changes and Utilization Management on the Use of First-Line Antidiabetic Medication Classes for the Treatment of Type 2 Diabetes Mellitus in a Commercial Population

Purpose: While metformin has a long track record regarding its efficacy and safety, newer classes like sodium-glucose cotransporter 2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists have also proven to not only be very effective in lowering A1c, but certain agents may provide additional cardiovascular, renal, and weight loss benefits as well. Recent 2023 American Diabetes Association (ADA) guidelines de-emphasized metformin as the de facto first-line pharmacologic agent in favor of selecting first-line agents based on patient-specific factors and treatment goals. Analysis of the prescription claims data can provide insight into the prescribing patterns of these newer agents over the past 2 years for any shifts in therapy in response to the changes in the guidelines. The objectives of this study is to compare the changes in utilization of different first-line antidiabetic classes in the treatment of Type 2 Diabetes Mellitus (T2DM), as monotherapy or combination therapy, in commercial population from January 1, 2021, and June 30, 2023.

Methods: This study is a retrospective analysis of prescription claims data identifying utilization of first-line antidiabetic classes. The classes of interest are biguanides, SGLT2, GLP-1, DPP-4, thiazolidinediones (TZD), and sulfonylureas (SU). Insulins and GLP-1 indicated for anti-obesity are excluded. The two study groups are plans with an initial metformin Step Therapy and plans with no utilization management in place. The primary objective will be to assess the changes in the proportion of 30-day supply claims for each class among the total antidiabetic utilizers from 2021 to 2023 between the two study groups. Key secondary objective include the difference in the proportion of non-metformin monotherapy for new antidiabetic utilizers. Another secondary objective is the difference between the proportion of utilizers for different type of combination therapy. Secondary endpoints will be reported as per utilizer per month (PUPM).

Results: Work-in-progress, N/A

Conclusion: Work-in-progress, N/A