US medical visits for diabetes have increased from 29 million in 1994 to 45 million in 2007. The proportion of visits in which no medication was prescribed increased from 15% to 20% over the same period. However, the mean number of diabetes medications prescribed per visit increased from 1.06 in 1994 to 1.45 in 2007.
Significant shifts in the types of medications used for diabetes were also evident. In 1994, 38% of the office visits studied involved patients using insulin, compared with 28% in 2007. Sulfonylureas were prescribed at 67% of visits in 1994 but at only 34% of visits in 2007. Metformin was not available in 1994 but was prescribed at 54% of visits in 2007. With the increase in combination therapies and the advent of newer, more expensive agents, aggregate drug expenditures increased by 87% over the past 6 years, from $6.7 billion in 2001 to $12.5 billion in 2007.
This analysis describes several important trends that warrant consideration. First, as evidenced by the declining proportion of visits requiring a medication, diabetes is probably being diagnosed earlier in its course, as other studies have reported. This trend may mean greater opportunity to control the disease and reduce its complications, which likely requires more (and more intensive) therapy, as is reflected in these data.
In addition, the American Diabetes Association lowered its target for glycemic control during the period of analysis in this study, and physicians appear to be treating more aggressively with more combination therapy as a result.
The marginal benefit of newer, more expensive medications would have to be substantial to be worth the cost. Of course, less tangible benefits, such as convenience and patient satisfaction, which may lead to improved patient compliance and adherence with therapy, should be factored in.
