{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:45:19Z","timestamp":1773290719958,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,3,18]],"date-time":"2014-03-18T00:00:00Z","timestamp":1395100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS019859"],"award-info":[{"award-number":["R01HS019859"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6\u2009months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to\/addition of insulin 31\u2013365\u2009days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time\u2010dependent variable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 41\u2009233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12\u2009months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (&lt;1%). HbA1c% was strongly associated with intensification (adjusted hazard ratios [HR] 1.59, 3.62, 4.44, and 5.52 for HbA1c 6.5% to &lt;7%, 7% to &lt;7.5%, 7.5 to &lt;8%, and \u22658%, respectively, all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, compared with HbA1c\u2009&lt;\u20096.5%). In patients initially on monotherapy, age modified the HbA1c effect: at HbA1c\u2009&lt;\u20097%, the HR differed little between middle\u2010aged and older patients; at HbA1c\u2009\u2265\u20097%, the HR decreased with older age (e.g., age 40\u201349\u2009years and HbA1c\u2009\u2265\u20098%: HR 8.14; age\u2009\u2265\u200980\u2009years and HbA1c\u2009\u2265\u20098%: HR 4.44; compared with age\u2009\u2265\u200980\u2009years and HbA1c\u2009&lt;\u20096.5%). Within 1\u2009year, 84.3% achieved HbA1c\u2009&lt;\u20098%; 65.1% achieved HbA1c\u2009&lt;\u20097%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinicians appear to be applying treatment intensification guidelines and individualizing therapy by considering patient age, achieving glycemic control among most incident diabetes patients. Copyright \u00a9 2014 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.3610","type":"journal-article","created":{"date-parts":[[2014,3,18]],"date-time":"2014-03-18T06:35:54Z","timestamp":1395124554000},"page":"699-710","source":"Crossref","is-referenced-by-count":32,"title":["Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME\u2010DM) study"],"prefix":"10.1002","volume":"23","author":[{"given":"Marsha A.","family":"Raebel","sequence":"first","affiliation":[{"name":"Kaiser Permanente Colorado Institute for Health Research  Denver CO USA"},{"name":"University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences  Aurora CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Colorado Institute for Health Research  Denver CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily B.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Colorado Institute for Health Research  Denver CO USA"},{"name":"University of Colorado School of Medicine  Aurora CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Xu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Colorado Institute for Health Research  Denver CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"O'Connor","sequence":"additional","affiliation":[{"name":"HealthPartners Institute for Education and Research  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodi B.","family":"Segal","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa G.","family":"Butler","sequence":"additional","affiliation":[{"name":"Center for Health Research Southeast Kaiser Permanente Georgia  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie A.","family":"Schmittdiel","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. 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