Comparative persistence and adherence with newer anti-hyperglycemic agents to treat patients with type 2 diabetes in the United States

Objectives: Non-adherence and non-persistence to anti-hyperglycemic agents are associated with worse clinical and economic outcomes in patients with type 2 diabetes. This study evaluated treatment persistence and adherence across newer anti-hyperglycemic agents (canagliflozin, dapagliflozin, sitagliptin, saxagliptin, linagliptin, liraglutide, or exenatide).

Methods: This retrospective cohort study of Truven Health Analytics Marketscan databases included adult patients with type 2 diabetes whose first pharmacy claim for a newer anti-hyperglycemic agent was between February 1, 2014 and July 31, 2014. Treatment persistence and adherence were assessed for 12 months after the first claim (post-index). Persistence was defined as no gap ≥90 days between the end of one pharmacy claim and the start of the next pharmacy claim post-index. Adherence used two definitions: proportion of days covered (PDC) and medication possession ratio (MPR). Multivariable analyses of non-persistence (hazard ratios) and adherence (odds ratios) were adjusted for baseline demographics, drug cost, clinical characteristics, and other anti-hyperglycemic agents.

Results: A total of 11,961 patients met all study selection criteria. Persistence rates at 12 months were significantly greater (p?p?=?0.83; PDC?=?0.79) and canagliflozin 300?mg (MPR?=?0.92; PDC?=?0.81) were greater than for the other index anti-hyperglycemic agents (MPR?=?0.33–0.75; PDC?=?0.33–0.72). Consistent results for treatment persistence and adherence were observed in multivariable analyses that were adjusted baseline characteristics.

Conclusions: Canagliflozin was associated with better treatment persistence and treatment adherence compared with other anti-hyperglycemic agents in real-world settings.     

Nested identities as cognitive drivers of strategy

Research Summary: Organizations face tensions to conform to industry norms for legitimacy yet differentiate for competitive advantage when implementing strategies. We suggest this tension is due to and resolved through organizations’ cognitive negotiations of multiple levels of identity. Through an inductive study in the recreational vehicle industry, we find that organizations concurrently draw on identities at the organizational, industry, and strategic group levels to formulate and enact specific competitive actions. Specifically, we find that organizational identity relates to decisions on product offerings; industry identity relates to downstream strategy; and strategic group identity relates to upstream strategy, firm boundaries, and expansion mode. Our findings highlight the importance of strategic group identity and inform a grounded model describing how organizations draw upon different levels of identity to influence strategy. Managerial Summary: Many managers experience tensions of differentiating their firms’ competitive actions from rivals, while conforming with industry norms and practices. In this article, we argue that a manager can navigate these tensions by understanding their firm, strategic group, and industry identities and how these identities interrelate. Through a qualitative case study of the U.S. recreational vehicle industry, we show that each level of identity influences different competitive actions, with firm identity connected to product offerings, industry identity related to managing downstream distribution, and strategic group identity related to firm boundary and acquisition strategies. Overall, strategic group identity is the most critical for managers as this level filters how they view competitors and provides the rules of competition.     

Economic modelling of costs associated with outcomes reported for type 2 diabetes mellitus (T2DM) patients in the CANVAS and EMPA-REG cardiovascular outcomes trials

Aims: To model direct medical costs associated with reductions in cardiovascular disease (CVD) events in T2DM patients reported in the CANVAS and EMPA-REG trials, which assessed the cardiovascular safety of canagliflozin and empagliflozin, respectively.

Materials and methods: Costs were modeled from a US managed care organization (MCO) perspective for the CVD outcomes included in both trials: three-point major adverse cardiovascular event (MACE) and its components (cardiovascular-related death, nonfatal myocardial infarction, nonfatal stroke), as well as heart failure requiring hospitalization. The rate of CVD events averted (difference between study drug and placebo) was projected to the portion of an MCO T2DM population matching the respective trial’s inclusion criteria. A targeted literature search for paid amounts directly associated with each CVD event provided the unit costs, which were applied to the projected number of events averted, to calculate costs avoided per member per year (PMPY). One-way sensitivity analyses were performed on events averted, unit costs, and percentages of trial-applicable patients.

Results: Based on three-point MACE events averted, costs avoided PMPY of $6.17 (range: $1.27–$10.94) for CANVAS and $2.75 ($0.19–$4.83) for EMPA-REG were estimated. Costs avoided for individual components of MACE ranged from $0.77 to $3.84 PMPY for CANVAS and from -$0.97 (additional costs) to $1.54 for EMPA-REG. PMPY costs avoided for heart failure were $2.72 for CANVAS and $1.32 for EMPA-REG.

Limitations and conclusions: Models assumed independent, non-recurrent outcomes and were restricted to medical costs directly associated with the trial-reported events. The reductions in CVD events in T2DM patients reported for both CANVAS and EMPA-REG project to a positive cost avoidance for these events in an MCO population. The analysis did not include an assessment of the impact on total cost, as the costs associated with adverse events, drug utilization or other clinical outcomes were not examined.     

Class formation and commodity chains in the making of regional monocultures: Agrarian reform from above and below in Mexico's henequen and cotton zones

This paper analyses the rise and fall of two regional monocultures in Mexico: the henequen zone in the southern state of Yucatán and the cotton‐growing area of La Laguna. Both regions experienced a dramatic expansion of commodity production between 1870 and 1910, but their key crops came to be cultivated under different labour regimes: debt peonage in the case of henequen and wage labour in the case of cotton. The process of class formation that unfolded in each region culminated in the 1930s in different kinds of crises. In Yucatán, a political struggle between hacienda owners and the federal government resulted in an agrarian reform “from above.” In La Laguna, class conflict between rural wageworkers and the landed bourgeoisie forced an agrarian reform “from below.” These previously distinct labour regimes converged in subsequent decades, however, as rural producers became de facto wageworkers on state‐organized and state‐administered production units known as collective ejidos. Ultimately, changes in the global markets for cotton and henequen, combined with the inability of the Mexican state to reconcile the political logic of agrarian clientelism with shifting commodity chain dynamics, resulted in the collapse of these regional monocultures in the late 20th century.     

The uncertainty challenge of contingent collaboration

Contingent knowledge workers will play an increasingly important role in organisational success as workers transition in and out of project‐based innovation teams with more frequency. Our research finds that collaborators in the contingent, high‐skill workforce face uncertainty challenges to their work that are unique from the independent, contingent professionals more often studied. The article proposes a theoretical framework of uncertainty to guide us in understanding collaborative contingent knowledge workers’ work experience. Interviews with postdoctoral researchers reveal four findings about the influence of these highly uncertain work environments on collaborative contingent knowledge workers – collaboration isolation, frustrated independence, performance anxiety and internalised blame. Perhaps most concerning is that the workers internalise the negative impacts as personal failings instead of recognising them as consequences of a poorly designed work environment. This study argues for the need to manage and mitigate different sources of uncertainty to avoid creating an unnecessary burden on contingent knowledge workers, and to enable a sustainable, contingent knowledge workforce.     

Development and transformation of collaborative networks in events

This study examines the mechanisms by which and the reasons that leaders of non-profit organizations transform interorganizational collaborative networks through event attendance. Drawing from a two-wave survey, this study examines the interorganizational networks of 30 individuals who participated in both waves, along with the reported activities of 121 individuals who participated in the second wave of the survey. This mixed methods study found that events transformed participants’ weak ties into strong ties and promoted development of collaborative networks. Further, the study found that participants’ motivations for attending the event and following up with contacts afterward focused on sharing resources and deepening connections. Implications for understanding how events promote formation and transformation of collaborative networks are discussed.     

Sustainable travel writing? Exploring the ethical dilemmas of twenty-first-century travel writers

There is a paucity of academic literature on travel writing that examines travel writers and their perceived influence on sustainability. This article addresses this lacuna by exploring how travel writers understand their responsibilities and reflects on ethics in their profession, particularly in how foreign destinations and cultures are portrayed. This is significant because some travel writers have been accused of contributing to what interviewees called the “Lonely Planet Syndrome”, the notion that writing about a place will introduce and encourage mass tourism, changing the original state of the place for the worse. In this qualitative, phenomenological study, data were collected from 23 in-depth interviews with twenty-first-century travel writers and analysed using an Interpretive Phenomenological Analysis. Findings suggest that while some interviewees expressed anxiety about their perceived accountability to mediate foreign cultures responsibly, others embraced their role as a cultural mediator. They cared about local cultures and wanted to write in responsible ways by supporting more sustainable outcomes, reflected in the themes of cross-cultural understanding, socio-cultural and environmental advocacy and promoting benefits of tourism to communities. Future studies could include exploring the role of travel editors, travel writers’ professional knowledge and the growing role of travel blogs.     

The effects of social TV on television advertising effectiveness

Social TV is the use of communication devices to connect with family and friends watching other TV screens. Plausible arguments suggest both positive and negative effects of social TV viewing on ad-effectiveness. This study contributes by providing evidence for the direction of social TV's effects. The results of a controlled laboratory experiment suggest that the benefits of social TV, principally its association with live TV and therefore less ad-avoidance, come at the cost of negative distraction effects. Like normal coviewing, social TV viewing distracts from ad-processing, reducing unaided recall and brand attitude favorability, compared to individual (solus) viewing. However, social TV messaging about ads improved brand attitude. Perceived creativity increased the likelihood of ad-related messaging. Social TV also has an additional source of distraction, multitasking, but in this study, multitasking did not further reduce ad-effectiveness compared to coviewing. The paper concludes with implications for advertisers and future research.     

Attitudes about EU expansion and zero‐sum thinking

EU expansion can be seen as a positive‐sum process benefiting all countries by creating larger markets that stimulate more productive economies through increased specialization and economies of scale, implying that the general public in all countries should favour expansion. Contrarily, expansion can be perceived as zero‐sum. Capital and production relocate from higher to lower wage regions while labour does the opposite, possibly raising unemployment and reducing wages in the higher wage regions. The general public in these countries may come to oppose EU expansion attributing any deterioration in their work situation to the gains of new citizens of the European Union. Analysis of changes in Irish attitudes towards EU expansion in 2002, 2007 and 2009 finds no evidence of a link from lowered economic conditions to increased opposition to EU expansion. The only evidence for zero‐sum thinking is that diminished economic circumstances are associated with increased opposition to immigration, but this is not associated with increased opposition to further EU expansion.