OBJECTIVES: To understand gender difference in treatment pattern & clinical outcome of type 2 diabetes patients.

METHODS: Optum® de-identified Market Clarity Dataset, which links medical, and pharmacy claims with EHR data was used for this analysis. It included patients diagnosed between Jan 2017 to Dec 2017 who were continuously eligible for 6 months pre and 60 months post-index. Patients who had been previously diagnosed with diabetes and age less than 18 years were excluded. To ensure homogeneity between the gender cohort, propensity score matching (PSM) was applied based on demographic factors such as age, insurance type, region, ethnicity, and comorbidity profile. Treatment pattern in terms of prescribed medications transition (switch/addition) and clinical outcome (HbA1C) were captured from the data. Markov modeling was performed to estimate treatment transitions and to calculate adjusted hazard ratio with 95% confidence interval between male and females. A Kaplan-Meier analysis was done to predict likelihood and the time to treatment switch.

RESULTS: Of the 48,700 diabetes patients 25,811 (53%) were female, 33,603 (69%) were Whites, 54.8% were commercially insured and 83% with age more than 50 years. Comorbidities mainly hypertension, cardiovascular problems and chronic kidney disease were found in 80% of the patients. In terms of treatment pattern, Biguanides (Metformin, 87.7%) was the most common initial treatment followed by sulfonylurea derivatives for both the genders. The most common transition in both the genders were dose escalation. Females were more likely to switch to another oral hypoglycemic therapy (OR: 1.66) or insulin therapy (OR: 2.54) with a poor glycemic control (avg. HbA1c: female:7.9, male:7.4).

CONCLUSIONS: This study showed that the current treatment pattern is not optimal to achieve desired glycemic control in females. The possible cause for poorer glycemic control could be differences in glucose homeostasis and physiological factors. Further research on adherence can be done to add more insight.