Characterization of Patients with Type 2 Diabetes (T2D) Who Discontinue DPP-4is following Insulin Initiation

Abstract

While discontinuation of oral drugs, such as DPP-4i, at the time of insulin initiation is not uncommon, the characteristics associated with this discontinuation are not well understood. We conducted a retrospective database study using the Optum claims data to describe the prevalence of and factors associated with discontinuation of DPP-4i among patients on dual therapy of metformin and DPP-4i after initiating insulin. Our study included adult T2D patients on this dual therapy who initiated insulin (index) from Jan 2006-Sep 2015. 3,388 T2D patients met the study criteria; mean age: 62 years, 55% male, and 61% and 88% reported micro- and macrovascular complications, respectively. 32% (n=1086) of the study population discontinued DPP-4i therapy within 12 months after insulin initiation, with 1075 patients discontinuing in the first 3 months. Median time to discontinuation was 25 days (IQR 13-31 days). Available patient characteristics between continuers vs. discontinuers are described in TABLE. Data available from claims showed that patients who discontinue had higher out of pocket costs and higher proportion of renal and liver disease. Limitation of this study is lack of information on A1C and other clinical variables such as BMI. A Cox regression model will be employed to further investigate if these factors are predictive of discontinuation. Disclosure G. Fernandes: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Research & Development. Stock/Shareholder; Self; Merck & Co., Inc.. Stock/Shareholder; Spouse/Partner; Janssen Research & Development. K. Iglay: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. Z. Liu: Employee; Self; Merck & Co., Inc. R. Shankar: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; NGM Biopharmaceuticals. I. Gantz: Employee; Self; Merck Sharp & Dohme Corp. S. Rajpathak: Employee; Self; Merck & Co., Inc..