Medicaid Managed Care
Diabetes (Actos drug is used to treat type II of diabetes) mellitus is the sixth leading cause of death in the United States (2000). Over 10 million Americans are diagnosed with type-2 diabetes (Generic Avandia is used to treat high blood sugar levels that are caused by a type of type 2 diabetes), and an additional 5.5 million are estimated to have the disease but are undiagnosed. Evidence shows that the prevalence of diabetes increases with age and varies by gender, race and ethnicity. Current research consistently points to “latent” prevalence cohorts and recommends earlier treatment interventions. Accordingly, practice patterns have moved to earlier and more aggressive treatment as well as preventive care aimed at delaying disease onset or slowing disease progression.
Literature on racial disparities, access and outcomes shows variations in mortality from major diseases, including, by race. It is thought that diabetes is responsible for 8.5% of the difference in mortality rates between African Americans and Caucasians. According to a report from the Centers for Disease Control and Prevention (CDC), African Americans are twice as likely to have diabetes (treating type 2 diabetes) as Caucasians. A report published by the Institute of Medicine states racial minorities tend to receive lower-quality healthcare than Caucasians, even when controlling for age, income, severity of disease and insurance status.
The pathophysiology of type-2 diabetes (Canadian Glucophage is used to treat a type of diabetes type 2 diabetes) involves a combination of peripheral insulin resistance, impaired insulin secretion and excessive glucose production. Insulin resistance manifests early in the disease and is linked to cardiovascular risk factors, such as dyslipidemia and hypertension. Metformin and thiazolidinediones (TZDs) are two agents that are known to be insulin-sensitizing drugs. Metformin works by decreasing hepatic production of glucose while increasing insulin sensitivity in peripheral tissues. TZD’s primary mechanism is to improve peripheral tissue insulin sensitivity. Rosiglitazone and pioglitazone are the only TZDs currently available in the United States.
The decision as to which drug is the optimal choice for first-line therapy is not always very clear. Each drug has grounds on which it could be considered first-line therapy for diabetic patients. Metformin has been shown to reduce mortality and is commonly chosen as first-line treatment for diabetes (controlling blood sugar levels). Pharmacodynamics also often guide the choice of treatment for given populations. For instance, diabetic patients who are obese are commonly given metformin due to limited associated weight gain. In addition, metformin holds the potential to protect against macrovascular disease; it is associated with a significant reduction in myocardial infarctions. An additional advantage of metformin is its availability of less expensive generic formulations. TZDs, on the other hand, act by increasing tissue sensitivity to insulin; therefore, use of TZDs is safe and most effective in patients who do not have a long history of diabetes (Diabecon canadian it maintains proper blood sugar balance) since the pancreas is still producing insulin in these patients. Some recent studies have suggested TZDs have better improvement of lipid profile, lowering insulin requirement and lowering HbAlc as compared with metformin.
The purpose of this study is to identify patient characteristics that are associated with the use of TZD or metformin among enrollees in a Medicaid managed care organization (MCO). Given the significant impact of diabetes in the African-American population and the potential impact of therapies in improving outcomes, this study also aims to examine possible racial disparities in the prescribing of newer TZDs versus metformin.