Comparison of anti‐diabetic drug prescribing in children and adolescents in seven European countries

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The incidence of both type 1 and type 2 diabetes is rising among children and adolescents.• Data on the prevalence of type 1 and type 2 diabetes are limited.• Routine clinical databases can be used to study the prevalence and epidemiology of treatment, depending on the completeness of data capture and their representativeness of the whole population.WHAT THIS STUDY ADDS• The prevalence of insulin prescribing appears to vary among countries, being highest in Sweden (3.5 per 1000 population) and lowest in Italy (1.1 per 1000 population).• The prevalence of oral anti‐diabetic prescribing ranges from 0.08 per 1000 population in Sweden and Germany to 0.21 per 1000 population in the UK; however, the total number of patients receiving oral anti‐diabetics is low.• It is possible to use the same study protocol across clinical databases in Europe to study the prevalence of type 1 diabetes in children.• Routine clinical databases can identify the prevalence of type 1 diabetes prescribing and could be used to study the secular changes in disease prevalence in children.AIMS The aim of this study was to compare the prevalence of diabetes in children across seven European countries, when using prescribing of anti‐diabetics as a proxy for diabetes. A secondary aim was to assess the potential for collaboration between countries using different databases in diabetes research.METHODS Data were obtained from population‐based clinical databases in seven European countries. The study population comprised children aged 0–18 years. Prescriptions were categorized using the Anatomic Therapeutic Chemical (ATC) classification. The one‐year user prevalence in 2008 was calculated for each country and stratified by age and sex.RESULTS We studied a total of 5.8 million children and adolescents. The prevalence of insulin prescribing varied between 1.1 and 3.5 per 1000 population, being highest in Sweden and lowest in Italy. In all countries, novel insulin analogues were the most commonly used insulins. The prevalence of oral anti‐diabetic prescribing ranged from 0.08 per 1000 individuals in Sweden and Germany to 0.21 per 1000 population in the UK. Overall, the absolute number of oral anti‐diabetic users was very low.CONCLUSION This study shows that there is a varying frequency of type 1 diabetes in children and adolescents across Europe. We also demonstrated that it is possible to obtain similar information from different clinical databases within Europe, which would allow continuous monitoring of type 1 diabetes. Owing to the lack of indications in most of the databases, this approach is less suitable for type 2 diabetes.

Long term trends in oral antidiabetic drug use among children and adolescents in the Netherlands

“…There are few studies on prescription patterns and epidemiology of OAD use in children and adolescents . Neubert et al .…”

“…There are limited data available on the incidence and prevalence of paediatric oral antidiabetic drug (OAD) use despite its importance in the treatment of children and adolescents with type 2 and, to a lesser extent, type 1 diabetes where it can be used to improve body mass index (BMI) as well as insulin sensitivity . Although insulin and metformin (in children aged 10 years and older) are the only antidiabetic agents currently approved for use in children and adolescents, other antidiabetic medicines (e.g.…”

Drug use profile in outpatient children and adolescents in different Italian regions

“…Wide international variation exists also in the prevalence rates of other, less common, classes of drugs used for chronic treatment in children, such as anti-epileptic and anti-diabetic drugs [5,6]. Such heterogeneity in different parts of the world may reflect differences both in prescription habits and in prevalence of diseases.…”

Authors’ response to Bachmann and Hoffman’s comments on psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study

“…(11) Our final summary Finally, our team is privileged to have been granted use of many different databases in Europe (UK, The Netherlands, Germany, Sweden, Denmark, Italy and Norway) (Sturkenboom et al 2008;Rani et al 2008;Neubert et al 2011), Asia (Taiwan and Hong Kong) (Chui et al 2014) and the World Health Organization Vigibase (Star et al 2012) for pharmacoepidemiological studies; all these databases have their strengths and limitations. It is important to interpret the results in light of the strengths, limitations and other published…”