A S Geier1, I Wellmann2, J Wellmann2, H Kajüter3, O Heidinger3, G Hempel4, H W Hense5. 1. Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany. Electronic address: ageier@uni-muenster.de. 2. Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany. 3. Epidemiological Cancer Registry of North Rhine-Westphalia, Münster, Germany. 4. Institute of Pharmaceutical and Medical Chemistry, University of Münster, Germany. 5. Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany; Epidemiological Cancer Registry of North Rhine-Westphalia, Münster, Germany.
Abstract
AIMS: We evaluated the patterns and determinants that influence the selection, timing and duration of first-line antihyperglycaemic drug (AHD) treatment in patients with type 2 diabetes in Germany, focusing specifically on treatment-naive AHD initiators. METHODS: Pharmacy dispensing claims data were linked with a cohort of patients newly enrolled in a German Disease Management Program for type 2 diabetes (DMP-DM2) between 2003 and 2009. We examined uptake of first-line pharmacotherapy in previously unmedicated patients and identified predictors of receiving AHD therapy in general and metformin in particular using multivariable regression analyses. RESULTS: There were 27,138 unmedicated patients with type 2 diabetes and 47.0% of them were started on AHD treatment within 5 years after enrollment. Initial severity of diabetes was the major predictor of receiving first-line pharmacotherapy. Metformin accounted for 63% of newly prescribed AHD in 2003 and more than 80% in 2009 while sulfonylureas accounted for only 10%. Initiating metformin as first-line AHD was associated with younger age, higher BMI, lower HbA1c, and shorter diabetes duration (multivariate p<0.001 for all). Therapy switch or step-up was less frequent among metformin initiators than sulfonylurea initiators. CONCLUSIONS: The majority of patients were not started on AHD therapy within 5 years after enrollment. In line with recent therapy guidelines, current first-line antihyperglycaemic treatment was increasingly based on metformin. AHD initiators started on sulfonylurea were generally more advanced in their disease and were started later on primary pharmacotherapy.
AIMS: We evaluated the patterns and determinants that influence the selection, timing and duration of first-line antihyperglycaemic drug (AHD) treatment in patients with type 2 diabetes in Germany, focusing specifically on treatment-naive AHD initiators. METHODS: Pharmacy dispensing claims data were linked with a cohort of patients newly enrolled in a German Disease Management Program for type 2 diabetes (DMP-DM2) between 2003 and 2009. We examined uptake of first-line pharmacotherapy in previously unmedicated patients and identified predictors of receiving AHD therapy in general and metformin in particular using multivariable regression analyses. RESULTS: There were 27,138 unmedicated patients with type 2 diabetes and 47.0% of them were started on AHD treatment within 5 years after enrollment. Initial severity of diabetes was the major predictor of receiving first-line pharmacotherapy. Metformin accounted for 63% of newly prescribed AHD in 2003 and more than 80% in 2009 while sulfonylureas accounted for only 10%. Initiating metformin as first-line AHD was associated with younger age, higher BMI, lower HbA1c, and shorter diabetes duration (multivariate p<0.001 for all). Therapy switch or step-up was less frequent among metformin initiators than sulfonylurea initiators. CONCLUSIONS: The majority of patients were not started on AHD therapy within 5 years after enrollment. In line with recent therapy guidelines, current first-line antihyperglycaemic treatment was increasingly based on metformin. AHD initiators started on sulfonylurea were generally more advanced in their disease and were started later on primary pharmacotherapy.
Authors: Mostafa A Al-Alusi; Lin Du; Ning Li; Michael W Yeh; Xuemei He; Lewis E Braverman; Angela M Leung Journal: Thyroid Date: 2015-08-17 Impact factor: 6.568