OBJECTIVE—Although postchallenge hyperglycemia is a well-established feature of type 2 diabetes, its association with risk of mortality is uncertain. Therefore, the aim of this study was to assess the independent association of fasting and 2-h glucose levels with all-cause and cardiovascular disease (CVD) mortality. RESEARCH DESIGN AND METHODS—We analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study, a prospective cohort study of U.S. adults examined in the NHANES II, and focused on the 3,092 adults aged 30–74 years who underwent an oral glucose tolerance test at baseline (1976–1980). Deaths were identified from U.S. national mortality files from 1976 to 1992. To account for the complex survey design, we used SUDAAN statistical software for weighted analysis. RESULTS—Compared with their normoglycemic counterparts (fasting glucose [FG] <7.0 and 2-h glucose <7.8 mmol/l), adults with fasting and postchallenge hyperglycemia (FG ≥7.0 and 2-h glucose ≥11.1 mmol/l) had a twofold higher risk of death after 16 years of follow-up (age- and sex-adjusted relative hazard [RH] 2.1, 95% CI 1.4–3.2). However, adults with isolated postchallenge hyperglycemia (FG <7.0 and 2-h glucose ≥11.1 mmol/l) were also at higher risk of death (1.6, 1.0–2.6). In proportional hazards analysis, FG (fully adjusted RH 1.10 per 1 SD; 95% CI 1.01, 1.22) and 2-h glucose (1.14, 1.00–1.29) showed nearly identical predictive value for mortality. Similar trends were observed for CVD mortality. CONCLUSIONS—These results suggest that postchallenge hyperglycemia is associated with increased risk of all-cause and CVD mortality independently of other CVD risk factors.

OBJECTIVE -Clinical trials provide information regarding the safety and efficacy of medications used to manage type 2 diabetes but do not elucidate drug effectiveness in a typical managed care environment. The aim of this study was to characterize "real-world" drug utilization patterns from both a prescriber and a patient perspective.RESEARCH DESIGN AND METHODS -We conducted a retrospective analysis of a large administrative pharmacy claims database, using data on continuously pharmacy benefiteligible members prescribed oral hypoglycemic agents (OHAs).RESULTS -The 12-month persistence rate for the OHA cohort was low, ranging from 31% for ␣-glucosidase inhibitors to 60% for metformin; compliance rates varied between 70 and 80%. During the first 12 months of therapy, 36% of the patients remaining on therapy at 12 months had one or more therapy modifications. The mean number of therapy changes increased with the length of patient follow-up, with more than half of all patients experiencing at least one therapy change over the duration of follow-up.CONCLUSIONS -These findings document the wide variation in utilization patterns associated with pharmacological management of type 2 diabetes, suggesting that opportunity exists to optimize its pharmacological management.

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This retrospective cohort study compared real‐world clinical and healthcare‐resource utilization (HCRU) data in patients with type 2 diabetes using basal insulin (BI) who switched to insulin glargine 300 units/mL (Gla‐300) or another BI. Data from the Predictive Health Intelligence Environment database 12 months before (baseline) and 6 months after (follow‐up) the switch date (index date, March 1, 2015 to May 31, 2016) included glycated haemoglobin A1c (HbA1c), hypoglycaemia, HCRU and associated costs. Baseline characteristics were balanced using propensity score matching. Change in HbA1c from baseline was similar in both matched cohorts (n = 1819 in each). Hypoglycaemia incidence and adjusted event rate were significantly lower with Gla‐300. Patients switching to Gla‐300 had a significantly lower incidence of HCRU related to hypoglycaemia. All‐cause and diabetes‐related hospitalization and emergency‐department HCRU were also favourable for Gla‐300. Lower HCRU translated to lower costs in patients using Gla‐300. In this real‐world study, switching to Gla‐300 reduced the risk of hypoglycaemia in patients with type 2 diabetes when compared with those switching to another BI, resulting in less HCRU and potential savings of associated costs.