Geospatial distribution of the adoption of dipeptidyl-peptidase-4 inhibitors for type 2 diabetes among Medicare beneficiaries

IF 2.1 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Spatial and Spatio-Temporal Epidemiology Pub Date : 2025-02-01 DOI:10.1016/j.sste.2025.100711

Jack Cordes , Robert J. Glynn , Alexander M. Walker , Sebastian S. Schneeweiss

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Abstract

Objective

To characterize the geospatial distribution of the adoption of dipeptidyl-peptidase-4 inhibitor (DPP-4i) antidiabetics versus second generation sulfonylureas (SU).

Methods

Using Medicare claims data 2012–2017, two cohorts were built with new-users of either sitagliptin or saxagliptin each versus active comparator SU. For each ZIP Code tabulation area (ZCTA), the proportion DPP-4i prescribing was used in a local indicator of spatial association hotspot analysis. Multilevel logistic models were used to quantify the variation in medication use at the individual, ZCTA, state, and region levels.

Results

DPP-4i utilization proportion was low (sitagliptin median = 0.22; interquartile range 0.15 to 0.33; saxagliptin median = 0.025; 0.00 to 0.069). Clustering was observed for sitagliptin (Moran's I = 0.32) and saxagliptin (Moran's I = 0.20). States and ZCTAs accounted for 8.1 % and 13.3 % of variation in sitagliptin and saxagliptin prescribing, respectively.