Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands

BMJ Open Diabetes Res Care. 2020 Jan;8(1):e000767. doi: 10.1136/bmjdrc-2019-000767.

Abstract

Rationale and objectives: Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands.

Methods: We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population.

Findings: During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date.

Conclusions: Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.

Keywords: drug utilization; standards of care; treatment algorithms.

MeSH terms

  • Aged
  • Biguanides / therapeutic use*
  • Biomarkers / analysis
  • Blood Glucose / analysis*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / pathology
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / analysis
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / therapeutic use*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prognosis
  • Retrospective Studies
  • Sulfonylurea Compounds / therapeutic use*

Substances

  • Biguanides
  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • Sulfonylurea Compounds
  • hemoglobin A1c protein, human