Change of initial oral antidiabetic therapy in type 2 diabetic patients

Abstract

Objective To explore the 'real-life' therapy of type 2 diabetes mellitus with oral antidiabetic drugs (OADs). Methods From the PHARMO Record Linkage System comprising linked drug dispensing and clinical laboratory data from approximately 2.5 million individuals in the Netherlands, among others, new users of OADs were identified in the period 1999-2004. New users, aged 30 years and older, without insulin use before cohort entry date and with at least one year follow-up were included. We determined per initial therapy patient characteristics and first therapy change. Results Overall 35,514 patients were included. Metformin and sulfonylureas (SU) were the most frequent initial therapy. Patients on thiazolidinedione (TZD) monotherapy had lower percentages baseline HbA1c C 7% compared to patients on metformin and SU. The proportion of patients still on initial therapy after one year ranged from 46% (TZDs) to around 60% (SU). Among patients starting on monotherapy, add-on (15-20%) and discontinuation (16-25%) of therapy occurred most frequently. In patients starting on combination therapy, a switch occurred in 30% of the patients. Conclusion In more than 40% of the patients a change in initial OAD-therapy is already observed in the first year of therapy. Maintaining patients on initial therapy remains a challenge.

Antihyperglycaemic treatment patterns, observed glycaemic control and determinants of treatment change among patients with type 2 diabetes in the United Kingdom primary care: a retrospective cohort study

“…This latter observation does not seem to be coherent as discontinuation would be associated with adequate glycaemic control; however, there will be patients restarting a different OAD shortly after discontinuing. When comparing the one-year persistence of initial OAD treatment with other published studies there was similarity with some studies [14,16], whilst there were clear differences with others [15]. The range of persistence rates can be explained by the settings where the studies were conducted, by the outcome definitions applied, and by the length of follow-up considered for the reported treatment changes.…”

“…Similarly, the ADVANCE trial reported that at baseline 43% of patients were on oral monotherapy glucose lowering agent, 59% on sulfonylureas, and 38% on metformin [13]. A study conducted in PHARMO for the period 1999–2004 also reported sulfonylureas (53.2%) and metformin (40.2%) as the most frequently used initial OAD therapies [14]. Metformin use as first OAD therapy seems to be increasing in recent years in other countries as well [15].…”

Influence of Comorbidities on Therapeutic Progression of Diabetes Treatment in Australian Veterans: A Cohort Study

“…In a Dutch study of more than 46,000 new users of antidiabetic medicines, the proportion of patients with an addition or switch of antidiabetic treatment at 1 year ranged from 20.2% with a sulfonylurea initial treatment to 25.7% with metformin initial treatment [16]. In two earlier American studies involving 85,888 members of an American managed care organization and 19,900 members of a pharmacy benefit management organization, rates of therapeutic progression at 1 year were 24.5% [17] and 17.2% respectively [18].…”

Budget Impact Analysis of Metformin Sustained Release for the Treatment of Type 2 Diabetes in The Netherlands

“…As metformin SR is an alternative to metformin IR, we identified which patients would be able to switch from SoC to metformin SR and who would continue on metformin IR. Factors considered in this respect were (1) the discontinuation of metformin IR amongst newly diagnosed patients (16.1%), (2) the potential market share of metformin SR as calculated from medicine issue registries from the United Kingdom (22.53%), and (3) the percentage of patients currently on metformin IR who could be actively switched to metformin SR (0.1%) [5]. As this BIA covers multiple years, type 2 diabetes patient population growth was taken into account.…”

“…Treatment with metformin immediate release (IR) has proven to be effective in clinical trials; however, adverse events (AEs) are a common problem. A Dutch study showed that 34.5% of the patients on metformin IR experienced AEs, and 11.4-16.1% discontinued their treatment within the first year after initiation [4,5]. Medication nonadherence, partially due to (gastrointestinal) AEs and difficult treatment regimens, is a well-known problem in type 2 diabetes patients [6].…”