Trends in Diabetes Treatment and Monitoring among Medicare Beneficiaries.
BACKGROUND
Diabetes is a costly and common condition, but little is known about recent trends in diabetes management among Medicare beneficiaries.


OBJECTIVE
To evaluate the use of diabetes medications and testing supplies among Medicare beneficiaries.


DESIGN/SETTING
Retrospective cohort analysis of Medicare claims from 2007 to 2014.


PARTICIPANTS
Traditional Medicare beneficiaries with a diagnosis of diabetes in the current or any prior year.


MAIN MEASURES
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.


KEY RESULTS
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.


CONCLUSIONS
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.