Table 1.
Baseline characteristics
| No insulin (n = 2,270,244 [80.7%]) | Long-acting insulin only (n = 235,939 [8.4%]) | Short-acting insulin (n = 308,281 [11.0%]) | Total (N = 2,814,464) | |
|---|---|---|---|---|
| Age, years, mean (SD) | 63.2 (12.9) | 63.8 (12.1) | 59.3 (15.6) | 62.8 (13.2) |
| Age category, years | ||||
| 18–39 | 116,955 (5.2) | 9,245 (3.9) | 39,891 (12.9) | 166,091 (5.9) |
| 40–64 | 975,749 (43.0) | 100,305 (42.5) | 133,876 (43.4) | 1,209,930 (43.0) |
| ≥65 | 1,177,540 (51.9) | 126,389 (53.6) | 134,514 (43.6) | 1,438,443 (51.1) |
| Sex | ||||
| Female | 1,133,171 (49.9) | 118,258 (50.1) | 159,340 (51.7) | 1,410,769 (50.1) |
| Male | 1,137,073 (50.1) | 117,681 (49.9) | 148,941 (48.3) | 1,403,695 (49.9) |
| Race/ethnicity | ||||
| Asian | 101,883 (4.5) | 5,965 (2.5) | 6,943 (2.3) | 114,791 (4.1) |
| Black | 389,379 (17.2) | 44,447 (18.8) | 57,153 (18.5) | 490,979 (17.4) |
| Hispanic | 311,200 (13.7) | 32,475 (13.8) | 34,506 (11.2) | 378,181 (13.4) |
| White | 1,390,533 (61.3) | 143,523 (60.8) | 197,773 (64.2) | 1,731,829 (61.5) |
| Other/unknown | 77,249 (3.4) | 9,529 (4.0) | 11,906 (3.9) | 98,684 (3.5) |
| Income, $ | ||||
| <40,000 | 719,128 (31.7) | 85,033 (36.0) | 102,342 (33.2) | 906,503 (32.2) |
| 40,000–74,999 | 657,488 (29.0) | 66,178 (28.0) | 81,615 (26.5) | 805,281 (28.6) |
| 75,000–124,999 | 505,143 (22.3) | 46,692 (19.8) | 62,991 (20.4) | 614,826 (21.8) |
| 125,000–199,999 | 188,909 (8.3) | 16,249 (6.9) | 24,838 (8.1) | 229,996 (8.2) |
| ≥200,000 | 89,207 (3.9) | 6,892 (2.9) | 13,802 (4.5) | 109,901 (3.9) |
| Other/unknown | 110,369 (4.9) | 14,895 (6.3) | 22,693 (7.4) | 147,957 (5.3) |
| Region | ||||
| Midwest | 519,407 (22.9) | 54,774 (23.2) | 77,692 (25.2) | 651,873 (23.2) |
| Northeast | 309,505 (13.6) | 31,791 (13.5) | 40,684 (13.2) | 381,980 (13.6) |
| South | 1,185,188 (52.2) | 122,049 (51.7) | 154,295 (50.1) | 1,461,532 (51.9) |
| West | 252,831 (11.1) | 27,056 (11.5) | 35,211 (11.4) | 315,098 (11.2) |
| Other/unknown | 3,313 (0.1) | 269 (0.1) | 399 (0.1) | 3,981 (0.1) |
| Insurance | ||||
| Commercial | 975,345 (43.0) | 84,160 (35.7) | 133,334 (43.3) | 1,192,839 (42.4) |
| Medicare Advantage | 1,294,899 (57.0) | 151,779 (64.3) | 174,947 (56.7) | 1,621,625 (57.6) |
| Diabetes type | ||||
| Type 1 | 12,454 (0.5) | 4,760 (2.0) | 71,986 (23.4) | 89,200 (3.2) |
| Type 2 | 2,257,790 (99.5) | 231,179 (98.0) | 236,295 (76.6) | 2,725,264 (96.8) |
| Noninsulin glycemic medication* | ||||
| DPP-4 inhibitor | 204,534 (9.0) | 33,199 (14.1) | 18,364 (6.0) | 256,097 (9.1) |
| GLP-1RAs | 97,465 (4.3) | 30,313 (12.8) | 20,859 (6.8) | 148,637 (5.3) |
| Metformin | 1,302,576 (57.4) | 140,444 (59.5) | 105,950 (34.4) | 1,548,970 (55.0) |
| SGLT2 inhibitor | 75,293 (3.3) | 15,759 (6.7) | 10,908 (3.5) | 101,960 (3.6) |
| Sulfonylureas | 492,215 (21.7) | 68,379 (29.0) | 30,163 (9.8) | 590,757 (21.0) |
| Thiazolidinediones | 116,720 (5.1) | 15,380 (6.5) | 8,460 (2.7) | 140,560 (5.0) |
| Comorbidities†‡ | ||||
| Cancer | 198,904 (8.8) | 20,881 (8.9) | 25,263 (8.2) | 245,048 (8.7) |
| Cardiovascular | 696,013 (30.7) | 89,602 (38.0) | 118,347 (38.4) | 903,962 (32.1) |
| Cerebrovascular | 269,164 (11.9) | 36,421 (15.4) | 50,323 (16.3) | 355,908 (12.6) |
| Cirrhosis | 22,775 (1.0) | 4,057 (1.7) | 6,016 (2.0) | 32,848 (1.2) |
| Chronic kidney disease stage 3–4 | 198,286 (8.7) | 38,553 (16.3) | 54,595 (17.7) | 291,434 (10.4) |
| Chronic kidney disease stage 5 | 28,327 (1.2) | 6,434 (2.7) | 11,251 (3.6) | 46,012 (1.6) |
| Dementia | 81,912 (3.6) | 11,070 (4.7) | 19,563 (6.3) | 112,545 (4.0) |
| Depression | 351,649 (15.5) | 44,666 (18.9) | 67,653 (21.9) | 463,968 (16.5) |
| Heart failure | 231,292 (10.2) | 37,618 (15.9) | 57,641 (18.7) | 326,551 (11.6) |
| Baseline neuropathy | 479,757 (21.1) | 87,665 (37.2) | 127,939 (41.5) | 695,361 (24.7) |
| Peripheral vascular disease | 314,470 (13.9) | 53,065 (22.5) | 78,561 (25.5) | 446,096 (15.9) |
| Retinopathy | 250,882 (11.1) | 55,581 (23.6) | 91,916 (29.8) | 398,379 (14.2) |
Data are n (%) unless otherwise indicated. DPP-4, dipeptidyl peptidase 4; GLP-1RA, glucagon-like peptide 1 receptor agonist; SGLT2, sodium–glucose cotransporter 2.
†
Comorbidities were ascertained from all claims during the 12 months preceding the index date. Glucose-lowering therapy was characterized based on prescriptions filled during the 120 days preceding the index date.