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Medicaid Managed Care: RESULTS

Patient Characteristics

A total of 3,041 patients met the inclusion criteria; 793 patients filled a prescription for at least one TZD and 2,248 patients had at least one metformin claim (Table 1). The population was mostly composed of African-American patients (60.1%). Compared with the proportion of African Americans at 52% in the overall Medicaid population over the same timeframe, the higher percentage in our study is expected given the higher prevalence of diabetes (Generic Avandia is used to treat high blood sugar levels that are caused by a type of type 2 diabetes) among African Americans. A larger percentage of females were represented in our sample (71.6%) than in the Maryland Medicaid population (60% female). This is expected given the higher prevalence of diabetes (Avandamet canadian used in the management of type 2 diabetes: Rosiglitazone maleate and metformin hydrochloride) among females.

The distribution of ages revealed an older population with over half of the population being 50 years or older (54.6%). This composition is older than that of the overall Medicaid population, in which 51% of the population is under 18 years old. Similarly, this is an expected result, since diabetes (managing type 2 diabetes) prevalence increases with age. A slight majority of patients resided in the nonurban area (58.3%). Many patients (54.9%) had one or more comorbidities prior to receiving the index drug. Overall, most patients (81.9%) did not have diabetic complications per medical claims records. More patients had claims for other oral diabetes drugs (31.7%) than insulin (22.8%) prior to use of the index drug. Most patients were initiated on metformin (73.9%) as opposed to TZDs (26%).

Distribution of Characteristics by Index Drug

African-American patients were prescribed metformin initially more frequently (77.8%) than non-African Americans (68.0%). Both drugs were used at nearly the same rate for females and males. Among females, 74.1% of prescriptions were for metformin versus 73.5% among males. We observed the incident use of TZDs increases with the age. Within the youngest age group, 18-39-year-olds, 20.7% had used TZDs. It increased incrementally up to the oldest age group, 60 years and older, in which 30.1% were initiated TZDs. Among those who lived in the urban regions, 80.4% received metformin. In contrast, only 69.3% of patients living in nonurban settings received metformin. A higher percentage of TZD versus metformin patients (62.4% vs. 52.2%) had preexisting comorbidities. Also, more TZD than metformin patients (26.4% vs. 15.2%) had preexisting diabetes (Actoplus Met medication is a combination of two oral diabetes medicines that help control blood sugar levels) complications. TZD patients had more usage of other diabetes drugs than metformin patients; 34.6% in the TZD group had prior use of oral diabetes drugs as opposed to 30.74% in the metformin group. A larger portion of TZD patients (36.7%) had used insulin, compared to fewer than one-fifth (17.9%) of metformin patients.

Analytical Models

The first multivariate model (Table 2) assessed the association of age, gender, race and residential setting with the initiation of TZDs. In this adjusted model, patients were more likely to receive a TZD if they were older (OR=1.014; 95% CI 1.007, 1.021; p=0.0001). They were less likely to receive TZDs if they were African-American (OR=0.748; 95% CI 0.627, 0.892; p=0.0013) or lived in an urban area (OR=0.616; 95% CI 0.513, 0.739; pO.0001). Gender was not a statistically significant predictor.

In the second model, we accounted for all of the predictive variables. In this model, patients were more likely to receive a TZD than metformin if they were older (OR=1.011; 95% CI 1.003, 1.018; p= 0.0040), had a preexisting comorbidity (OR=1.250; 95% CI 1.040, 1.503; p=0.0174), had preexisting diabetes(Actos drug is used to treat type II of diabetes) complications (OR=1.453; 95% CI 1.175, 1.797), had prior use of oral  (OR=1.213; 95%CI 1.008, 1.461; p=0.0414) or had previous use of insulin (OR=2.763; 95% CI 2.274, 3.356; pO.0001). Those less likely to be initiated on TZDs were African-American (OR=0.678; 95% CI 0.565, 0.815; pO.0001) or urban residents (OR=0.579; 95% CI 0.479,0.699; pO.0001).

Category: Diabetes

Tags: Diabetes, managed care, Medicaid, race, thiazolidinediones

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