A Five-Year Study on Treatment Changes in Hypoglycemia-Associated Medications: Towards Personalized Diabetes...

Background: Understanding patient-specific patterns of medication intensification and de-intensification is essential for personalizing diabetes management and minimizing hypoglycemia risk in patients with type 2 diabetes. Objectives: To assess treatment changes in hypoglycemia-associated medications over five years and explore patient characteristics associated with these changes. Methods: We conducted a longitudinal cohort study using the IADB.nl database containing prescription data from Dutch community pharmacies. Individuals aged ≥35 years with at least two dispensations of glucose-lowering medications were identified. We estimated transition probabilities of changes in hypoglycemia-associated medications (sulfonylureas and/or insulin) using a Markov model for each year of follow-up. Associations with age, sex, and estimated hypoglycemia risk were explored with regression analysis. Results: Overall, 25,057 patients were included. Medication remained unchanged for the majority of the patients in the follow-up period. De-intensification increased from 4.7% (Year 1) to 6.5% (Year 5), while intensification decreased from 7.7% to 6.9% over the same period. Markov models showed that patients predominantly remained in a no change state over 5 years (transition probabilities: 0.92-0.94). High estimated hypoglycemia risk, age and being female were associated with intensification and/or de-intensification. Conclusions: While treatment regimens remained unchanged for most patients, de-intensification of hypoglycemia-associated medications increased modestly over five years. Factors like hypoglycemia risk, age and sex influenced changes. These findings support the need for personalized, risk-stratified approaches to diabetes medication management.