Ambulatory Treatment Of Type 2 Diabetes Mellitus In The United States, 1997-2012

  1. G. Caleb Alexander, MD, MS1,2,4
  1. 1Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
  2. 2Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  3. 3Program on Prevention Outcomes and Practices, Stanford Prevention Research Center; Stanford University School of Medicine, Stanford, California
  4. 4Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
  1. Corresponding Author: G. Caleb Alexander, Email: galexand{at}


Background Type 2 diabetes is increasingly common and associated with substantial morbidity and mortality.

Methods We conducted descriptive analyses of cross-sectional data using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory physician practices in the US. We focused on visits for diabetes among patients 35 years or older. We used the IMS Health National Prescription Audit of pharmacy dispensing to derive information about drug expenditures.

Results Ambulatory diabetes visits increased from 23 million [M] treatment visits in 1997 (95% confidence intervals [CI], 21-25M) to 35M (CI 32-37M) in 2007 and declined to 31M visits by 2012 (CI 27-31M). Between 1997 and 2012 biguanide use increased, from 23% (20-26%) to 53% (50-56%) of treatment visits. Glitazone use grew from 6% (CI 4-8%) in 1997 to 41% (CI 39-43%) of all visits in 2005, but declined to 16% (CI 8-12%) by 2012. Since 2005, DPP-4 inhibitor use increased steadily, representing 21% (CI 18-23%) of treatment visits by 2012. GLP-1 agonists accounted for 4% of treatment visits in 2012. Visits where two or more drug compounds were used increased nearly 40% from 1997 to 2012. Between 2008 and 2012, drug expenditures increased 61%, driven primarily by use of insulin glargine and DPP-4 inhibitors.

Conclusions Declining sulfonylurea and glitazone use has been offset by increases in DPP-4 inhibitor use and, to a lesser degree, use of GLP-1 agonists. Treatment of diabetes has grown in complexity while older treatments continue to be replaced or supplemented by newer therapies.

  • Received September 5, 2013.
  • Accepted October 29, 2013.

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