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. 2015 May;31(5):414-24.
doi: 10.1097/AJP.0000000000000124.

Opioid use in the management of diabetic peripheral neuropathy (DPN) in a large commercially insured population

Pravinkumar R Patil  1 , Jonathan Wolfe, Qayyim Said, Jeremy Thomas, Bradley C Martin
Affiliations

Opioid use in the management of diabetic peripheral neuropathy (DPN) in a large commercially insured population

Pravinkumar R Patil et al. Clin J Pain. 2015 May.

Abstract

Objective: To examine the proportion of diabetic peripheral neuropathy (DPN) patients receiving pharmacologic DPN treatments and specifically to identify the rates and factors associated with opioid use and first-line opioid use.

Methods: A 10% sample of IMS-LifeLink claims data from 1998 through 2008 was used. The study population consisted of diabetic patients who met DPN criteria using a validated DPN algorithm. Multivariable logistic regression controlling for demographics, comorbidities, and other clinical characteristics was used to identify factors associated with any DPN pharmacologic treatment, any opioid use, and first-line opioid treatment. Sensitivity analyses were conducted to explore variations in exclusion criteria as well as opioid use definitions.

Results: A total of 666 DPN patients met inclusion criteria and pharmacologic treatment was received by 288 patients (43.24%) and of those, 154 (53.47%) had DPN-related opioid use and 96 (33.33%) received opioid as first-line treatment. Persons with diabetic complications were more likely to use opioids (odds ratio=4.53; 95% confidence interval, 1.09-18.92). Food and Drug Administration-approved DPN agents duloxetine 1.04% (n=3) and pregabalin 5.56% (n=16) had much lower rates of use. DPN-related drug use and DPN-related opioid usage increased as we used less restrictive samples in sensitivity analyses.

Conclusions: Opioids were the most frequently prescribed first-line agents for DPN. More than 50% of DPN patients remained untreated with pharmacologic agents 1 year after a DPN diagnosis.

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Figures

Figure 1
Figure 1. DPN identification, exclusion criteria and selection of primary and sensitivity analysis cohorts
Figure 2
Figure 2. Study period & description of DPN related and first line DPN drug use
See this image and copyright information in PMC

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