Trends in anti‐diabetic medication use, severe hyperglycaemia and severe hypoglycaemia among American Indian and Alaska Native Peoples, 2009–2013

Aims Type 2 diabetes (T2D) and its complications disproportionally affect American Indian and Alaska Native (AI/AN) peoples. Prescribing decisions for anti‐diabetic medications are complicated and require balancing medication benefits, costs and side effects. Little is known about trends in anti‐diabetic medication use as well as acute diabetes complications among AI/AN adults. Here, we examined patterns and trends in anti‐diabetic medication use and rates of hospital admissions or emergency department (ED) visits due to severe hypoglycaemia and hyperglycaemia among AI/AN adults with T2D. Materials and Methods We conducted a retrospective analysis of Indian Health Service (IHS) Improving Health Care Delivery Data Project. A total of 39 183 AI/AN adults aged ≥18 years with T2D who used IHS or Tribal health services during any of the fiscal years (FYs) 2009–2013 were included. Utilization rates of each class of anti‐diabetic medications and rates of severe hypoglycaemia and severe hyperglycaemia in emergency room and/or inpatient discharge diagnoses were calculated for each year. Longitudinal statistical models were fitted to examine time trends of anti‐diabetic medication use and complications. Results During 2009–2013, use of metformin (56.0%–60.5%), insulin (31.4%–35.9%) and dipeptidyl peptidase‐4 inhibitors (1.4%–9.0%) increased, whereas the use of sulfonylureas (40.3%–32.9%) and thiazolidinediones (TZDs, 31.6%–8.8%) decreased significantly. Trends in severe hypoglycaemia (1.6%–0.8%) and severe hyperglycaemia (2.0%–1.6%) declined gradually. Conclusions There were significant changes in the utilization of different anti‐diabetic medication classes during 2009–2013 among AI/AN adults with T2D. Concurrently, there were significant reductions in severe hypoglycaemia and severe hyperglycaemia.