Comparison of clinical characteristics in patients with type 2 diabetes among whom different antihyperglycemic agents were prescribed as monotherapy or combination therapy by diabetes specialists

Abstract

Aims/IntroductionWe compared clinical characteristics in patients with type 2 diabetes for whom different antihyperglycemic agents were prescribed as monotherapy or combination therapy by diabetes specialists in Japan.Materials and MethodsPrescription data for 2005, 2008 and 2011 from diabetes specialists' patient registries identified variables related to prescription of different antihyperglycemic agents.ResultsA total of 33,251 prescriptions in 2005, 25,119 in 2008 and 20,631 in 2011 were analyzed. Prescribing insulin was related to younger age, long duration of diabetes and glycated hemoglobin (HbA1c) ≥8.0%, but was negatively associated with obesity. Prescribing sulfonylureas was related to older age and long duration of diabetes, but not to obesity. Use of biguanides was related to younger age, short duration of diabetes and obesity, but was negatively associated with HbA1c ≥8.0%. A short duration of diabetes and HbA1c ≥8.0% were associated with use of a DPP‐4 inhibitor, but not with obesity. Prescribing GLP‐1 receptor agonists was related to younger age, obesity and HbA1c ≥8.0%. Odds ratios for each antihyperglycemic combination therapy were determined based on the characteristics of each included antihyperglycemic agent.ConclusionsThese results could be expected to reflect in part the consensus of diabetes specialists, and might provide guidance regarding pharmacotherapy in the clinical setting.

Choice of Treatment Regimen as Add-On to Insulin in Japanese Patients with Type 2 Diabetes Mellitus: Physicians’ Perspective in a Real-World Setting, Insight from a Web Survey

“…The progressive nature of T2DM associated with the loss of β-cell function results in deterioration of glycemic control, which entails treatment intensification with a combination of oral anti-diabetes drugs and glucagon-like peptide-1 receptor agonists (OADGs), and eventually insulin treatment [ 5 ]. The use of insulin has become quite prevalent in the Japanese population, with ~ 30% of patients receiving insulin either as a monotherapy or in combination with other OADGs [ 5 – 8 ]. Despite the availability of several OADGs and the increased use of insulin, most patients still fail to achieve glycemic control goals, which might possibly be due to increased risk of hypoglycemia, weight gain, and insufficient social support for the use of insulin, especially for patients with dementia or fear of injectables [ 8 , 9 ].…”

“…The use of insulin has become quite prevalent in the Japanese population, with ~ 30% of patients receiving insulin either as a monotherapy or in combination with other OADGs [ 5 – 8 ]. Despite the availability of several OADGs and the increased use of insulin, most patients still fail to achieve glycemic control goals, which might possibly be due to increased risk of hypoglycemia, weight gain, and insufficient social support for the use of insulin, especially for patients with dementia or fear of injectables [ 8 , 9 ]. Hence, improvement in glycemic control without increasing the risk of hypoglycemia and weight gain is required when using OADGs in combination with insulin.…”

Rationale and Design for the J-DISCOVER Study: DISCOVERing the Treatment Reality of Type 2 Diabetes in a Real-World Setting in Japan—A Protocol

“…Large-scale cohort studies in T2DM, such as the Japan Diabetes Complication and its Prevention prospective [ 6 , 9 ] and the Diabetes Clinical Data Management Study Group [ 5 , 10 ] studies in Japan, are often conducted at hospitals or clinics that specialize in diabetes. This is consistent with how diabetes studies are conducted overseas, including the landmark UK Prospective Diabetes study [ 11 ].…”

Comparison of baseline characteristics and clinical course in Japanese patients with type 2 diabetes among whom different types of oral hypoglycemic agents were chosen by diabetes specialists as initial monotherapy (JDDM 42)

“…[ 5 ] The first drug of choice has dramatically changed in Japan, since several new drugs, as represented by dipeptidyl peptidase-4 inhibitors (DPP-4I), have been developed during the last decade. [ 7 – 9 ] In fact, a recent study revealed that the top three initially prescribed hypoglycemic agents in Japan were DPP-4I, biguanides, and sulfonylureas in that order. [ 9 ]…”

“…The Japan Diabetes Clinical Data Management Study Group (JDDM) is one of the largest cohorts of Japanese diabetes specialists consisting of more than 120 leading clinical diabetologists in 98 facilities and has provided information on characteristics of patients with T2DM as well as hypoglycemic prescriptions in Japan. [ 7 , 8 , 10 , 11 ] Therefore, using JDDM data we sought to determine the factors that influence the choice of each of 3 hypoglycemic agents prescribed as initial monotherapy by specialists as well as the patients’ factors that influenced the continuation or discontinuation of the drug or the addition of another drug over a 1-year period. Such information would be helpful in guiding the treatment of patients with T2DM by diabetes specialists and physicians in general practice in clinical settings.…”