Long term patterns of use after initiation of oral antidiabetic drug therapy

Lamberts, E.J.F.; Nijpels, Giel; Welschen, L.M.C.; Hugtenburg, Jacqueline G.; Dekker, Joost; Souverein, Patrick C.; Bouvy, Marcel L.

doi:10.1002/pds.2089

Cited by 14 publications

(21 citation statements)

References 27 publications

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“…These analyses were adjusted for the following variables of interest and available within the database: duration of follow up, gender, age, coverage scheme and initial antidiabetic agent. Similar variables have been found to be of significance in previous studies . Hazard ratios (HR) and CIs are presented.…”

Section: Methodssupporting

confidence: 77%

“…Pre‐existing CVD and management of newly diagnosed type 2 diabetes can therefore be a difficult issue for physicians . Little information has been published regarding antidiabetic agent use in the primary care setting amongst newly treated type 2 diabetes patients , and the majority of information published has come from the United States with no studies having looked at how pre‐existing CVD medicine use affects treatment patterns. This study aims to provide prescribers and other health care professionals with an understanding of drug utilization in newly treated type 2 diabetes, at the population level, in a European country.…”

Section: Introductionmentioning

confidence: 99%

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Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients

Grimes

Bennett

Tilson

et al. 2015

Brit J Clinical Pharma

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Aims The aim was to describe the utilization of antidiabetic agents, in terms of persistence and regimen change, in the management of a cohort of newly treated type 2 diabetes patients and to investigate associated socio‐demographic and treatment factors. Methods A population‐based retrospective cohort study was conducted using the national pharmacy claims database in Ireland. Subjects were analyzed for persistence and regimen change. Cox proportional hazards regression examined associations of socio‐demographic and treatment factors on treatment patterns. Hazard ratios (HR) and 95% CIs are presented. Results A total of 20947 subjects were identified in the study over a 2 year period. Most were initiated on metformin (76%) or sulphonylureas (22%) and 77% were persistent with therapy 12 months after initiation. The likelihood of non‐persistence was significantly lower in the youngest (40–49 years) age groups (reference 60–69 years) (HR 1.62, 95% CI 1.42, 1.84) and those on sulphonylureas (HR 1.49, 95% CI 1.36, 1.64). The likelihood of receiving a regimen change was significantly lower in the older (80+ years) age groups (HR 0.63, 95% CI 0.56, 0.71), females (HR 0.91, 95% CI 0.86, 0.95), and those with pre‐existing CVD (1 vs. 0 CVD medicines) (HR 0.82, 95% CI 0.74, 0.90), and higher in those on sulphonylureas (HR 1.83, 95% CI 1.73, 1.94). Conclusions Type of treatment, pre‐existing CVD and demographic factors are shown to be associated with the observed treatment patterns. Guideline recommended agents were widely used on treatment initiation though a substantial minority were not initiated on the recommended first line agent. Use of guideline recommended agents was not as evident during treatment progression. Further optimization of initial and subsequent antidiabetic agent prescribing may be possible.

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Section: Methodssupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients

Grimes

Bennett

Tilson

et al. 2015

Brit J Clinical Pharma

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“…The low discontinuation rates of metformin-based therapy may also suggest that approximately 80% of the patients are adequately treated over longer periods. Our analysis was consistent with that of recent studies [18][19][20]. These findings provide additional valuable information to clinicians, patients and the public regarding the adoption and safety of metformin as an initial medication for new diabetes patients.…”

Section: Discussionsupporting

confidence: 81%

Retrospective analysis of primary and sequential care of type 2 diabetes patients in Taiwan

Chung¹

2017

Vascul Dis Ther

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Although oral antidiabetic drugs (OADs) are the first choice for type 2 diabetes treatment, the progressive nature of the disease will require switching to another OAD. The satisfaction of diabetes patients with current treatment is most unknown. We investigated the primary and sequential care of type 2 diabetes patients in Taiwan to understand the satisfaction of these diabetes patients. We used Taiwan's 2004Taiwan's -2008 National Health Insurance database to conduct a population-based, retrospective cohort study. The prevalence of diabetes in Taiwan increased from 3.95% to 4.45% from 2004 to 2008. The one-year annual incidence density was 1.04% to 1.11% from 2005 to 2008. The most frequent medication used in the primary care of type 2 diabetes patients was metformin (80.4%). During the study period, 79.3% of patients who used alpha glucosidase inhibitor modified their medication, and most of them switch to metformin as their second medication. Most patients who used metformin (76.8%) as their initial OAD maintained their metformin treatment after 720 days. Our analysis suggests that there is a significantly higher adherence rate in new diabetes patients that receive metformin treatment. The low rates of discontinuation of metformin may also suggest that approximately 80% of the patients are adequately treated over longer periods.

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“…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.…”

Section: Discussionmentioning

confidence: 59%

“…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]. …”

Section: Discussionmentioning

confidence: 99%

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

Maguire

Mitchell

Ruzafa³

2014

BMC Endocr Disord

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BackgroundThe initial treatment strategy for patients with type 2 diabetes includes lifestyle change recommendations. When patients are not successful in controlling their blood glucose levels through healthier lifestyle pharmaceutical agents are recommended. The objective of this study is to identify determinants of initial treatment change following initiation of non-insulin antihyperglycaemic treatment (OAD) for UK patients with type 2 diabetes.MethodsA retrospective cohort study using primary care data from the Clinical Practice Research Datalink between January 2006 and February 2011. Each patient had an OAD prescription. The main treatment pattern outcomes were discontinuation, switching, augmentation and initiation of insulin. Glycaemic control was assessed using HbA1c.Results63,060 patients initiated OAD therapy 2006–2010 and 3.4% were prescribed insulin during follow-up. 26% with at least four years of follow-up remained on the initial treatment. Metformin dominated (90%) in UK primary care. Around 75% had a record of HbA1c testing prior to initiating therapy. On initiating OAD, half the patients had HbA1c values >65 mmol/mol and one quarter >80 mmol/mol. The initial values of HbA1c were reduced after 12 months and remained stable. There were 15%-18% of patients whose values increased since initiating OAD. Increased baseline HbA1c is associated with increased chance of augmentation and decreased chance of discontinuation. HbA1c values at 1 year were associated with a three-fold increase in the chance of augmentation, 130% increase in the chance of switching and 14% increase in the chance of discontinuation with each 10 mmol/mol increase. Following initiation of OAD, HbA1c was reduced by an average of 16 mmol/mol during the first year.ConclusionThere are patients for whom glycaemic control worsens and a majority remained above the recommended level, suggesting an unmet need despite the availability of many OAD.

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Long term patterns of use after initiation of oral antidiabetic drug therapy

Abstract: This study shows that adherence to type 2 diabetes treatment guidelines for initial treatment is implemented on a large scale. Longitudinal patterns show that the majority of patients receive a small number of modifications to their drug regimen. Discontinuation rates were relatively low.

Cited by 14 publications

References 27 publications

Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients

Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients

Retrospective analysis of primary and sequential care of type 2 diabetes patients in Taiwan

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

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