The prescribing trend of oral antidiabetic agents for type 2 diabetes in Taiwan

Abstract

The purpose of this study was to evaluate the prescription trend and pattern of oral antidiabetic (OAD) medications, which are extensively used worldwide for treating type 2 diabetes, in 2 age groups.In this population-based study, data obtained from the National Health Insurance Research Database, Taiwan, were analyzed to investigate the prescription trend of all types of OAD medications during 2005 to 2012. We used descriptive statistics to demonstrate the trend of prescription patterns stratified by age (aged 65 years and above or younger than 65).Sulfonylurea (SU) was once the most commonly used drug, but the proportion of its prescription had declined gradually (76.83% in 2005 to 63.70% in 2012). Consequently, biguanide (BG) became the most commonly used drug since 2010 (64.31% in 2005 to 74.41% in 2012). In addition, the prescriptions of thiazolidinedione decreased significantly (9.20% in 2005 to 2.86% in 2012), whereas the usage of DPP-4 inhibitor increased with time (3.73% in 2009 to 19.64% in 2012). The treatment choice of SU and α-glucosidase inhibitor (AGI) was higher in elderly patients compared with the younger population (SU: 62.70% in 2012, AGI: 12.78% in 2012). Two-drug combination therapies were the prevalent treatment choices for patients with type 2 diabetes (44.77% in 2012), particularly in the elderly group; however, ≥3 drug combination therapies increased gradually during the study period, particularly in the younger group.This descriptive study presents the change in the prescription of OAD medication for different age groups during 2005 to 2012.

Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017

“…Use of sulfonylurea has thus reduced, and has been relegated in certain guidelines in relation to other glucose‐lowering agents . While the decrease in use of sulfonylureas in our study echoes that observed elsewhere, two interesting observations were seen . First, the use of sulfonylureas in the oldest population, the very group of patients to whom cautious use is advocated, was higher than that in the younger populations.…”

“…The increase in use of metformin as a favored drug was also observed in other studies . However, we observed that both the prevalence and the magnitude of rise in the use of metformin are lower in our population as compared with other studies; Chu and et al found that metformin was the most commonly prescribed medication at 74.4% in Taiwan, while the use of metformin in Denmark increased sharply from 23.1% in 1999 to 71.7% in 2014 . This may be due to the tertiary setting of ours, whereby patients may have underlying comorbidities such as end‐stage kidney disease that would contraindicate the use of metformin.…”

Clinical outcomes of basal insulin and oral antidiabetic agents as an add-on to dual therapy in patients with type 2 diabetes mellitus

“…The present study focused on comparing third antidiabetic agents because it has been revealed that the use of basal insulin is usually delayed; for instance, the results of a previous study found that Taiwanese patients received an average of 2.7 OHAs before starting basal insulin therapy 26 . Earlier studies on the treatment patterns of antidiabetic agents in Taiwan indicated that over 70% of dual therapy regimens involved a combination of metformin and sulfonylureas 14,15 . The resistance against the initiation of insulin may result from misconceptions about insulin, the inconvenience of injectable medications, and the easy accessibility of other oral treatment options, such as TZDs and DPP-4is 10 .…”

“…However, the initiation of insulin therapy is often delayed in clinical practice because most patients are reluctant to or inconvenienced by using injectable medications 10 .The role of basal insulin as an add-on antidiabetic agent remains unclear [11][12][13] . Previous studies have shown that the combination of metformin and sulfonylureas dominated in dual therapy in the early phase of disease management [14][15][16][17] , and other OHAs, such as thiazolidinediones (TZDs) and dipeptidyl peptidase-4 inhibitors (DPP-4is), are common treatment options after the failure of dual therapy 11,13,16 . Several observational studies compared insulin to OHAs and noted a significantly increased risk of CVDs or all-cause mortality associated with insulin 18-23 .…”

Anti-diabetic drugs prescription pattern by postgraduate students among type 2 diabetes patients attending a tertiary care hospital

“…The dual drug therapy of glimepiride with metformin was prescribed more compared to monotherapy and is similar to a study conducted in taiwan. 16 Metformin was prescribed as the single drug therapy in 20% and glimepiride in 11%. The choice of the monotherapy may be due to its affordability, less side effects, effects on weight and other pharmacokinetic parameters.…”