Utilización de fármacos hipoglucemiantes en el ámbito de la atención primaria de Málaga durante los años 2008-2012

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007–2013 in Catalonia: a population-based study

“… 38 Both side effects have been recently ruled out, 37 39 but the influence of these alarms, together with weight gain, the risk of heart failure and the increased risk of bone fractures in women observed with this class of drugs, has limited its use. The marginal use of GLP-1ra in our study is similar to that of a recent study conducted in the UK, 15 but in contrast with a substantial increase documented in another region of Spain, 17 Ireland and the USA. 9 13 The administrative restrictions and negative economic incentives of our institution (ICS) for the prescription of GLP-1ar may have contributed to the limited use of this therapeutic class.…”

“…A gradual increase in the prescription of antidiabetic agents has been previously reported in Spain 16 17 and in studies conducted worldwide throughout the same or overlapping years as in our study. 6–8 10–12 31 32 An increase in the use of combinations of oral antidiabetic drugs (OADs) has been consistently observed in several studies from different countries, 6 7 9 11 17 31 but the trends in its use as monotherapy vary among reports, with some describing an overall increase over time, 11 13 32 and others a progressive decrease. 6 9 31 Moreover, while the number of prescriptions of insulin in combination with an OAD has been shown to increase with time, 6 7 11 the use of insulin alone has been reported to remain stable, 17 33 to decrease 6 11 31 or even to increase.…”

“… 25 The decrease in AGIs might be explained by the high frequency of gastrointestinal side effects that led to the recommendation to only use them in people unable to use other oral glucose-lowering medications. 35 The decrease in the use of glitazones has been consistently documented in several studies that included data after 2007, 8 9 11–13 15 17 31–33 when the first regulatory warnings and the results of a meta-analysis alerted clinicians to cardiovascular risk associated with rosiglitazone, 36 37 and to a risk of bladder cancer with pioglitazone in 2011. 38 Both side effects have been recently ruled out, 37 39 but the influence of these alarms, together with weight gain, the risk of heart failure and the increased risk of bone fractures in women observed with this class of drugs, has limited its use.…”

“… 6–8 10–12 31 32 An increase in the use of combinations of oral antidiabetic drugs (OADs) has been consistently observed in several studies from different countries, 6 7 9 11 17 31 but the trends in its use as monotherapy vary among reports, with some describing an overall increase over time, 11 13 32 and others a progressive decrease. 6 9 31 Moreover, while the number of prescriptions of insulin in combination with an OAD has been shown to increase with time, 6 7 11 the use of insulin alone has been reported to remain stable, 17 33 to decrease 6 11 31 or even to increase. 32 Differences between drug schemes and studies may be attributable to health policy variations across countries, local professional expertise, physician's personal choice, study setting (eg, hospital vs primary care or insurance claims vs national database), or inclusion of both patients with T1DM and T2DM in some cases.…”

“… 6–9 11–13 15 17 31–33 This decline could be related to the recent recommendation of cautionary use in the elderly, 34 their worse safety profile, associated weight gain, unclear role in reducing long-term complications and/or to the availability of safer new therapeutic options. 5 Although a decrease in glinides and AGIs use has been reported in Spain, Japan and in the UK, 11 15 17 33 in our study the number of glinides prescriptions remained stable, which could be explained by the fact that in spite of their risk of hypoglycaemia, 5 they are the most used therapeutic class in patients with chronic kidney disease. 25 The decrease in AGIs might be explained by the high frequency of gastrointestinal side effects that led to the recommendation to only use them in people unable to use other oral glucose-lowering medications.…”