Use of more costly diabetes medications varies widely

Walid Gellad, M.D., M.P.H., of the VA Pittsburgh Healthcare System, and colleagues conducted a study involving 1,158,809 veterans with T2DM to evaluate the use of high-cost thiazolidinediones (rosiglitazone, pioglitazone) and long-acting insulin analogues (detemir, glargine) in the fiscal year 2009.

The researchers found that 78.3 percent of the patients received prescriptions for diabetes medications: 66.7 percent received an oral medication, 27.7 percent received insulin, and 16.1 percent received both. Thiazolidinedione use ranged from 1.4 to 25.4 percent across the 139 facilities, with a median of 8.2 percent. The median adjusted percentage of patients receiving insulin who used long-acting analogues was 40.6 percent, but ranged from 4.0 to 71.2 percent.

"While some variation is expected given reasonable differences in prescribing practices, the observed 18-fold variation across facilities was unexpected," the authors write. "Our findings suggest that while they may exert powerful effects on medication choice, formularies and utilization management tools can only go so far in standardizing health care delivery."

Several authors are employees of the VA.

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Journal reference: JAMA Internal Medicine

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