OBJECTIVE 1) To examine trends in the use of diabetes medications and 2) to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS We conducted a retrospective, cross-sectional analysis of 2003-2016 National Health and Nutrition Examination Survey (NHANES) data. We included people ≥18 years who had ever been told they had diabetes, had an HbA1c >6.4%, or had a fasting plasma glucose >125 mg/dL. Pregnant women and patients aged <20 years receiving only insulin were excluded. We assessed trends in use of ADA's seven preferred classes from 2003-2004 to 2015-2016. We also examined use by hypoglycemia risk (sulfonylureas, insulin, and meglitinides), weight effect (sulfonylureas, thiazolidinediones [TZDs], insulin, and meglitinides), cardiovascular benefit (canagliflozin, empagliflozin, and liraglutide), and cost (brand-name medications and insulin analogs). RESULTS The final sample included 6,323 patients. The proportion taking any medication increased from 58% in 2003-2004 to 67% in 2015-2016 (P < 0.001). Use of metformin and insulin analogs increased, while use of sulfonylureas, TZDs, and human insulin decreased. Following the 2012 ADA recommendation, the choice of drug did not vary significantly by older age, weight, or presence of cardiovascular disease. Patients with low HbA1c, or HbA1c <6%, and age ≥65 years were less likely to receive hypoglycemia-inducing medications, while older patients with comorbidities were more likely. Insurance, but not income, was associated with the use of higher-cost medications. CONCLUSIONS Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics. Substantial opportunities exist to improve pharmacologic management of diabetes.

中文翻译：

---

美国成年人使用降糖药的情况：国家健康与营养检查调查的分析。

目的1）检查糖尿病药物的使用趋势，以及2）确定医生是否按照美国糖尿病协会（ADA）的建议个性化糖尿病治疗。研究设计与方法我们对2003-2016年国家健康与营养检查调查（NHANES）数据进行了回顾性横断面分析。我们纳入了≥18岁的人们，他们被告知患有糖尿病，HbA1c> 6.4％或空腹血糖> 125 mg / dL。孕妇和年龄小于20岁的患者仅接受胰岛素治疗。我们评估了2003-2004年至2015-2016年间ADA的七个首选类别的使用趋势。我们还通过低血糖风险（磺脲类，胰岛素和美格替尼），体重影响（磺脲类，噻唑烷二酮[TZDs]，胰岛素和美格替尼）来检查使用情况，心血管益处（卡那列净，恩帕格列净和利拉鲁肽）和成本（品牌药和胰岛素类似物）。结果最终样本包括6,323名患者。服用任何药物的比例从2003-2004年的58％增加到2015-2016年的67％（P <0.001）。二甲双胍和胰岛素类似物的使用增加，而磺酰脲类，TZD和人胰岛素的使用减少。遵循2012年ADA的建议，药物的选择因年龄，体重或心血管疾病的存在而无明显变化。低HbA1c或HbA1c <6％且年龄≥65岁的患者接受低血糖诱导药物的可能性较小，而合并症的老年患者则更有可能。保险，而不是收入，与使用成本较高的药物有关。结论遵循ADA的建议，二甲双胍的使用有所增加，但是医生通常没有根据患者的特点进行个体化治疗。存在大量改善糖尿病药理管理的机会。