Trends and influences on use of antidiabetic drugs in England, 1992-2003

Walley, Tom; Hughes, Dyfrig; Kendall, Helen

doi:10.1002/pds.1089

Cited by 24 publications

(21 citation statements)

References 11 publications

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“…There was a highly significant increase in the use of BGs both for monotherapy and combination therapy. These trends are consistent with the reports from the UK, Italy, France, Taiwan and the USA. The present study showed the trends of the increase of the use of BG and the decrease of that of SUs reported by Kanatsuka in 2006 had become more pronounced.…”

Section: Discussionsupporting

confidence: 93%

Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002–2011 in Japan (JDDM32)

Oishi¹,

Yamazaki²,

Okuguchi³

et al. 2013

J of Diabetes Invest

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Aims/IntroductionSix kinds of oral antidiabetic drugs (OADs), including the new dipeptidyl peptidase 4 (DPP‐4) inhibitors, are available. The present study aimed to define trends within the prescribing patterns of OADs, as well as changes in glycemic control in Japan over a 10‐year period from 2002 to 2011.Materials and MethodsWe carried out a cross‐sectional study using data of type 2 diabetes mellitus patients from 24 clinics for 2002, 2005, 2008 and 2011. OAD use was analyzed combined with clinical data.ResultsSulfonylureas (SUs) were the most commonly used OAD, but their use for monotherapy markedly decreased over the study period. Biguanides (BGs) were the second most commonly used OAD, and their prescribing rate increased both for mono‐ and combination therapy. DPP‐4 inhibitors (DPP‐4I), released in 2009, were the third most commonly prescribed OAD in 2011 both for mono‐ and combination therapy. Among combination therapies, two OADs were mostly prescribed, but the use of three OADs and four OADs in 2011 was two‐ and 14.8‐fold those in 2002. These trends were accompanied by an improvement in average glycated hemoglobin from 7.5 ± 1.2% in 2002 to 7.1 ± 0.9% in 2011.ConclusionsThe OAD prescribing trend has moved away from monotherapy with SUs and toward combination therapies to achieve better glycemic control. Increased use of BGs and DPP‐4I was predominant in 2011. These trends were accompanied by an improvement of the glycated hemoglobin level.

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Section: Discussionsupporting

confidence: 93%

Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002–2011 in Japan (JDDM32)

Oishi¹,

Yamazaki²,

Okuguchi³

et al. 2013

J of Diabetes Invest

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“…Advances in technology and medication have been recognized as key drivers of health expenditure growth (16). Furthermore, there has been a trend toward more aggressive medical treatment of diabetes, i.e., increased use of various oral hypoglycemic agents, alone or in combination with insulin (17).…”

Section: Prescription Prevalences and Costsmentioning

confidence: 99%

Trends in Outpatient Prescription Drug Costs in Diabetic Patients in Germany, 1994–2004

et al. 2007

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OBJECTIVE -New antidiabetic medications have been introduced during the last decade, but their impact on health care cost is largely unknown. Prescription costs in diabetic patients in primary care in Germany were evaluated (1994 -2004).RESEARCH DESIGN AND METHODS -A total of 46,017 diabetic patients and 46,017 age-and sex-matched control subjects in 400 nationwide practices (2004) were compared with 29,956 diabetic patients and 13,226 control subjects (361 practices) in 1994 (data from IMS HEALTH). Inflation-adjusted age-and sex-standardized costs (ex-manufacturer prices) were calculated.RESULTS -Mean annual total prescription costs per diabetic patient were €559 in 2004 (€372 in 1994), equaling a 60% (standardized) increase (P Ͻ 0.01). Average costs for antidiabetic medication were €172 in 2004, a 100% increase (P Ͻ 0.01). The major antidiabetic cost factor was insulin and analogs, which accounted for 22% of total drug costs in diabetic patients in 2004 (17% in 1994). All oral antidiabetic drugs together accounted for 8% of total costs (6% in 1994). New drugs (glitazones, glinides, and insulins) accounted for 15% of total costs (40% of antidiabetic drugs) in 2004. A 40% increase (€387 vs. 286) in all non-diabetes-related drugs was due mainly to cardiovascular and lipid-lowering drugs. In nondiabetic patients, only a 30% cost increase was found (€210 vs. 147; P Ͻ 0.01).CONCLUSIONS -Prescription drug costs among diabetic patients increased 60% during the last decade, which was twofold higher than the increase in nondiabetic patients. New types of antidiabetic drugs accounted for a substantial cost share of the overproportional increase for diabetes treatment. Progress in pharmacological therapy is a key driver of drug expenditure growth in diabetes treatment. Diabetes Care 30:848 -853, 2007D uring the last decade, antidiabetic prescription patterns have become increasingly complex (1-3). This complexity is the result of both the expanding evidence obtained from major clinical trials on intensified treatment of type 2 diabetic patients (e.g., the U.K. Prospective Diabetes Study) and the launch of new medications such as human insulin analogs (4). In particular, continuously increasing prescription use of insulin was observed during the last decade in European countries (5,6). Since 1995, the number of insulin prescriptions has almost doubled in Germany (5). Currently, 27% of diabetic patients receive insulin prescriptions, based on German health insurance data (7). Among oral antidiabetic drugs, prescription use of biguanides increased fourfold during the last decade, whereas use of sulfonylureas has steadily declined (5).In most countries including Germany, the majority of diabetic patients are treated predominantly by general practitioners and internists. There has been no evaluation of current trends in prescription use and costs among diabetic patients in the German primary health care system. To our knowledge, there also has been no longitudinal cost analysis from other European countries. In 1994, we foun...

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“…However, many subjects with type 2 diabetes may be undetected, and many detected subjects may be undertreated [3,4]. Moreover, several earlier studies indicate that the utilisation of AHGDs varies pronouncedly, both between and within countries, and even within counties [5][6][7][8][9][10][11][12][13][14][15]. A comparison of the Nordic countries in 1985 suggested that greater utilisation was associated with a higher degree of obesity and a higher prevalence of diabetes [8].…”

Section: Introductionmentioning

confidence: 99%

Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels

et al. 2006

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Aims/hypothesis The aim of this study was to compare developments in the utilisation of antihyperglycaemic drugs (AHGDs) in ten European countries. Subjects and methods Data on the yearly utilisation of insulin and oral AHGDs were collected from public registers in Denmark, Finland, Norway, Sweden, Belgium, England, Germany, Italy, Portugal and Spain, and were expressed as defined daily doses per 1,000 inhabitants per day. Results Total AGHD utilisation increased everywhere, but at different rates and levels. Insulin utilisation doubled in England and Germany, but hardly changed in Belgium, Portugal or Italy. Sulfonylurea utilisation doubled in Spain, England and Denmark but was reduced in Germany and Sweden. Metformin utilisation increased greatly everywhere. There were two-to three-fold differences in AHGD utilisation even between neighbouring countries. In Finland, there were more users of both insulin (+120%) and oral AHGDs (+80%) than in Den- Diabetologia (2006) mark, and the daily oral AHGD doses were higher. In Denmark and Sweden, AHGD utilisation was equal in subjects aged <45 years, but in those ≥45 years of age, both insulin and oral AHGD utilisation were twice as high in Sweden. Conclusions/interpretation The ubiquitous increase in AHGD utilisation, particularly metformin, seems logical, considering the increasing prevalence of type 2 diabetes and the results of the UK Prospective Diabetes Study. However, the large differences even between neighbouring countries are more difficult to explain, and suggest different habits and attitudes in terms of screening and management of type 2 diabetes.

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Trends and influences on use of antidiabetic drugs in England, 1992-2003

Abstract: There has been a trend towards more aggressive treatment of diabetes. National guidance may have reinforced this but has not altered the trend. Specific evidence around metformin may have been very influential in increasing its use.

Cited by 24 publications

References 11 publications

Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002–2011 in Japan (JDDM32)

Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002–2011 in Japan (JDDM32)

Trends in Outpatient Prescription Drug Costs in Diabetic Patients in Germany, 1994–2004

Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels

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