Initiating second-line antidiabetic medication among older adults with type 2 diabetes on Metformin

BMC Geriatrics

Table 6 Odds of Receiving SFU or BI as Initial Second-Line Antidiabetic Medication Class by Covariates

Covariate	SFU	BI
Covariate	OR (95% CI)	OR (95% CI)
Poor Health^a
No	REF	REF
Yes	1.13 (1.05 - 1.21)	2.34 (2.14 - 2.55)
Sex
Male	REF	REF
Female	0.88 (0.86 - 0.91)	1.09 (1.04 - 1.14)
Age
65-67 years	REF	REF
68-70 years	0.98 (0.93 - 1.02)	0.83 (0.77 - 0.89)
70-74 years	1.07 (1.03 - 1.12)	0.85 (0.80 - 0.90)
75-79 years	1.18 (1.12 - 1.24)	0.93 (0.86 - 0.99)
≥80 years	1.32 (1.25 - 1.4)	0.97 (0.89 - 1.04)
Hemoglobin A_1c^b
<8%	REF	REF
8-10%	1.18 (1.12 - 1.24)	1.19 (1.08 - 1.31)
≥10%	1.33 (1.23 - 1.44)	3.49 (3.12 - 3.90)
Unavailable	1.53 (1.47 - 1.60)	3.35 (3.12 - 3.60)
Diabetes Complications Severity Index^c
0	REF	REF
1	0.92 (0.89 - 0.96)	1.09 (1.02 - 1.15)
2	0.95 (0.91 - 1.00)	1.12 (1.04 - 1.20)
≥3	0.92 (0.87 - 0.96)	1.25 (1.16 - 1.34)
Prescriber specialty
Family practice	REF	REF
Endocrine	0.50 (0.47 - 0.54)	1.14 (1.03 - 1.25)
General/Internal	1.00 (0.96 - 1.03)	0.95 (0.90 - 1.00)
Nurse/PA	0.85 (0.80 - 0.90)	1.10 (1.02 - 1.20)
Other/Missing	0.99 (0.95 - 1.04)	1.21 (1.13 - 1.30)
Health Plan Type
Other	REF	REF
Health maintenance organization	1.03 (0.99 - 1.07)	1.25 (1.18 - 1.31)
Preferred provider organization	1.06 (1.00 - 1.11)	0.88 (0.81 - 0.96)
Fill Year
2013	REF	REF
2014	0.86 (0.81 - 0.92)	1.08 (0.98-1.18)
2015	0.80 (0.75 - 0.85)	0.90 (0.82 - 0.99)
2016	0.90 (0.85 - 0.95)	1.28 (1.18 - 1.39)
2017	0.69 (0.65 - 0.73)	0.91 (0.84 - 0.99)

BI basal insulin, SFU sulfonylurea
^a Poor health was defined according to the following criteria modified from the 2019 Endocrine Society Guidelines for diabetes management in older adults: (1) end-stage conditions; (2) dementia; or (3) residence in a long-term nursing facility
^b Laboratory values are not routinely available in health plan administrative data sources unless submitted by the laboratory vendor as part of their contract with the health payer. For these data, 35% of submitted laboratory claims nationally included a result. The Unavailable category includes patients without evidence of a test (no claim), as well as those with evidence of a test but no available result
^c The Diabetes Complications Severity Index (DCSI) is a validated index composed of micro- and macrovascular complications of diabetes. In this analysis, we modified the DCSI by removing cardiovascular diagnoses that comprise the primary exposure variable. Scores were categorized as 0, 1, 2, and ≥3

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