Treatment patterns of drug-naive patients with type 2 diabetes mellitus: a retrospective cohort study using a Japanese hospital database

Abstract

BackgroundGuidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease. There exists a wide variation of preference for initial antidiabetes drugs (AD). The current database analysis aimed to understand the real world treatment patterns in drug-naive patients with T2DM in Japan.MethodsWe analyzed data of patients (≥ 18 years) diagnosed with T2DM between October 2012 and September 2016 from the Medical Data Vision, a Diagnosis Procedure Combination database. The primary objective was to determine the proportion of T2DM patients receiving each type of treatment as first-line therapy among the drug-naive cohort.ResultsOf the 436,546 drug-naive patients, 224,761 received their first-line T2DM treatment in the outpatient setting. The mean age of the patient population was 65.6 years at index date. Dipeptidyl peptidase-4 (DPP-4) inhibitor was the most prescribed (56.8%) outpatient AD monotherapy, followed by metformin (15.4%). DPP-4 inhibitors were prescribed over metformin in patients with renal disease (odds ratio [OR]: 4.20; p < 0.0001), coronary heart disease and stroke (OR: 2.22; p < 0.0001). Male (OR: 1.03; p = 0.0026), presence of diabetic complications [retinopathy (OR: 1.33; p < 0.0001), neuropathy (OR: 1.05; p = 0.0037), nephropathy (OR: 1.08; p < 0.0001)] and a high baseline HbA1c (OR: 1.45; p < 0.0001) received treatment intensification during 180 days.ConclusionDPP-4 inhibitors were the most prevalent first-line T2DM treatment followed by metformin in Japan. The findings from this retrospective analysis also support the previously published web survey results and can help understand the real world utilization of T2DM treatment.Trial registration Retrospectively registered

Fixed‐ratio combination of basal insulin and glucagon‐like peptide‐1 receptor agonists in the treatment of Japanese people with type 2 diabetes: An innovative solution to a complex therapeutic challenge

“…Metformin, which lowers blood glucose primarily by improving insulin sensitivity and reducing hepatic gluconeogenesis, may not necessarily be considered the optimal initial oral therapy for Japanese people with T2D. In fact, only approximately 10% of Japanese people with T2D are placed on metformin as initial OAD therapy 16,17 . In Japan, dipeptidyl peptidase‐4 (DPP‐4) inhibitors are preferentially prescribed 16–18 .…”

“…In fact, only approximately 10% of Japanese people with T2D are placed on metformin as initial OAD therapy 16,17 . In Japan, dipeptidyl peptidase‐4 (DPP‐4) inhibitors are preferentially prescribed 16–18 . According to Japanese claims‐based studies, DPP‐4 inhibitors are the most commonly (44.0%–54.8%) prescribed OAD as first‐line medication 16–18 .…”

“…In Japan, dipeptidyl peptidase‐4 (DPP‐4) inhibitors are preferentially prescribed 16–18 . According to Japanese claims‐based studies, DPP‐4 inhibitors are the most commonly (44.0%–54.8%) prescribed OAD as first‐line medication 16–18 . DPP‐4 inhibitors increase portal concentrations of endogenous glucagon‐like peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) by inhibiting DPP‐4, the enzyme that rapidly inactivates GLP‐1 and GIP 19 .…”

Benefits of the fixed‐ratio combination of insulin glargine 100 units/mL and lixisenatide (iGlarLixi) in Japanese people with type 2 diabetes: A subgroup and time‐to‐control analysis of the LixiLan JP phase 3 trials

“…One baseline characteristic explored in this analysis of LixiLan JP-O1 and LixiLan JP-O2 but not in the global LixiLan trials is use of DPP-4 inhibitor prior to the study. In Japan, DPP-4 inhibitors are the most commonly used OAD class, 34 reflecting the high sensitivity of Japanese people to this class of drugs. In LixiLan JP-O1 and LixiLan JP-O2, 45-50% of patients were using DPP-4 inhibitor at screening.…”

Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data

“…The use of metformin as a first-line antidiabetic drug has also been reported in other European countries such as the United Kingdom (80% of cases) [22], Italy (70%) [20], and France (62%) [37]. In contrast, in other countries like Japan, DPP-4i has been reported as the most prevalent outpatient antidiabetic monotherapy, followed by metformin [38]. In our study, metformin was the first line medication choice for patients with chronic renal failure, although with a lower prevalence than in patients without this condition.…”