Rapid Increase in the Use of Oral Antidiabetic Drugs in the United States, 1990–2001

Wysowski, Diane K.; Armstrong, Gary R.; Governale, Laura

doi:10.2337/diacare.26.6.1852

Cited by 94 publications

(83 citation statements)

References 15 publications

(7 reference statements)

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“…This study adds current and nationally projected estimates to previous studies describing the use of antidiabetic drugs (15)(16)(17)(18)(19). We documented a steady increase in the number of patients who used antidiabetic drugs and in the number of dispensed prescriptions in U.S. retail pharmacies.…”

Section: Discussionmentioning

confidence: 56%

“…This marks the continuation of a remarkable trend: in 1996, the year after metformin was approved in the U.S., 19.0% of all oral antidiabetic drug prescriptions were for metformin, and this proportion increased to 32.7% in 2001 (19). Almost 11.8 million patients (62.7% of all patients who received antidiabetic drugs) used single-ingredient metformin in 2012 (Table 1), and 44.9% of patients to whom metformin was dispensed used the drug as monotherapy (Table 2), consistent with recommendations by the American Diabetes Association and the European Association for the Study of Diabetes to use metformin as first-line therapy (20).…”

Section: Discussionmentioning

confidence: 96%

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Use of Antidiabetic Drugs in the U.S., 2003–2012

et al. 2014

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Since 2003, the number of adult antidiabetic drug users increased by 42.9% to 18.8 million in 2012. Metformin use increased by 97.0% to 60.4 million prescriptions dispensed in retail pharmacies in 2012. Among antidiabetic drugs newly approved for marketing between 2003 and 2012, the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin had the largest share with 10.5 million prescriptions in 2012. Rosiglitazone use plummeted to <13,000 prescriptions dispensed in retail or mail-order pharmacies in 2012. Concomitancy analyses showed that 44.9% of metformin use was for monotherapy. Between 33.4 and 48.1% of sulfonylurea, DPP-4 inhibitor, thiazolidinedione, and glucagon-like peptide 1 analog use was not accompanied by metformin. CONCLUSIONSThe antidiabetic drug market is characterized by steady increases in volume, and newly approved drugs experienced substantial uptake, especially DPP-4 inhibitors. The use of rosiglitazone has been negligible since restrictions were put in place in 2011. Further study is needed to understand why one-third to one-half of other noninsulin antidiabetic drug use was not concomitant with metformin use despite guidelines recommending that metformin be continued when other agents are added to treatment.In 2010, 18.8 million adults in the U.S. had been diagnosed with diabetes mellitus, 7.0 million additional Americans were affected by undiagnosed diabetes, and an estimated 1.9 million adults received a new diagnosis of diabetes during that year (1). The number of Americans with diabetes who have or have not received a diagnosis is expected to increase to 44

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 96%

Use of Antidiabetic Drugs in the U.S., 2003–2012

et al. 2014

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“…Our data underline the fact that antidiabetic treatment accounts for a substantial share of this rapid growth. This is not only related to an increasing prevalence of type 2 diabetes, but also is due to the approval of new costintensive types of antidiabetic drugs (3). Advances in technology and medication have been recognized as key drivers of health expenditure growth (16).…”

Section: Prescription Prevalences and Costsmentioning

confidence: 99%

“…uring the last decade, antidiabetic prescription patterns have become increasingly complex (1)(2)(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.…”

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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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“…A METFORMINA É UMA DAS DROGAS antidiabéticas orais mais comumente prescritas no mundo e deve manter essa posição apesar de inúmeros antidiabéticos orais que vêm sendo introduzidos no tratamento do diabetes melito tipo 2 (DM2) (1,2).…”

Section: Introductionunclassified

Metformina e AMPK: um antigo fármaco e uma nova enzima no contexto da síndrome metabólica

Jún

Ugolini

Santomauro

et al. 2008

Arq Bras Endocrinol Metab

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RESUMOA metformina é uma das drogas antidiabéticas orais mais prescritas mundialmente, entretanto seu mecanismo de ação permanece desconhecido. Os estudos do Diabetes Prevention Program Research Group demonstraram que tanto a administração de metformina como a mudança no estilo de vida (dieta e exercício físico) podem reduzir a incidência de diabetes melito tipo 2 (DM2). Uma possível conexão bioquímica entre essas duas terapias pode ser a proteína quinase ativada por AMP (AMPK). Essa enzima foi inicialmente descrita como um sensor energético celular, sendo ativada pelo exercício físico. Por outro lado, várias evidências experimentais indicam que a AMPK seja um alvo importante da ação da metformina. Este artigo discute as várias formas da regulação da AMPK, sugerindo um possível mecanismo para sua ativação pela metformina que envolve a formação de espécies reativas de nitrogênio. A ativação da AMPK determina ampla variedade de efeitos fisiológicos, incluindo o aumento da captação de glicose pelos músculos esqueléticos e aumento do catabolismo de lipídios, podendo ser interessante não apenas na prevenção e tratamento do DM2, mas também no contexto da síndrome metabólica. A descoberta da ativação da AMPK pela metformina faz dessa enzima importante alvo farmacológico. Metformin is one of the most commonly prescribed oral antidiabetic agents worldwide. However, its mechanism of action remains unknown. The Diabetes Prevention Program Research Group studies have shown that metformin administration and lifestyle-intervention (diet and exercise) reduce the incidence of Diabetes Mellitus type 2 (DM2). A possible biochemical connection between both therapies may be the AMP-activated protein kinase (AMPK). This enzyme was originally described as a sensor of cellular energy status, being activated in exercise. On the other hand, several experimental evidences indicate that AMPK may be an important target of metformin action. This paper discusses various ways for AMPK regulation, suggesting a possible mechanism for its activation by metformin that involves the production of reactive nitrogen species. AMPK activation determines a wide variety of physiological effects, including enhanced glucose uptake by skeletal muscle and enhanced lipid catabolism. Thus, it may be a key player not only in the prevention and treatment of DM2, but also in the development of new treatments for obesity and the metabolic syndrome. The finding of AMPK activation by metformin draws attention to this enzyme as an important pharmacological target.

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Rapid Increase in the Use of Oral Antidiabetic Drugs in the United States, 1990–2001

Cited by 94 publications

References 15 publications

Use of Antidiabetic Drugs in the U.S., 2003–2012

Use of Antidiabetic Drugs in the U.S., 2003–2012

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

Metformina e AMPK: um antigo fármaco e uma nova enzima no contexto da síndrome metabólica

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