Trends in medication use in patients with type 2 diabetes mellitus: a long-term view of real-world treatment between 2000 and 2015

Abstract

BackgroundDespite the availability of a variety of treatments, many patients with type 2 diabetes mellitus (T2DM) are not achieving glucose control. We analyzed successive waves of the Adelphi Real World Diabetes Disease Specific Programmes (DSPs) to assess treatment patterns reported by primary care physicians (PCPs) and specialists and the effect of treatment on levels of glucose control.MethodsData were collected between 2000 and 2015 in the US and EU5 (France, Germany, Italy, Spain, and the UK). Physicians completed patient record forms for the next 10 patients consulting with T2DM. Key aspects captured were change over time in therapy usage, time to insulin introduction, and glycated hemoglobin (HbA1c) levels.ResultsOver 12 DSP waves, 3,555 specialists and 5,109 PCPs completed questionnaires for 70,657 patients. Treatment patterns changed considerably over time as new agents were introduced. The number of agents prescribed per patient increased over time, as did HbA1c levels at which physicians stated they would introduce insulin. The greatest improvements in HbA1c levels occurred during 2000–2008, with little improvement since 2008.ConclusionIn this real-world setting, the proportion of patients with T2DM achieving good glucose control has not increased greatly since 2008. A better understanding of how to individualize treatment pathways may be required to improve control in these patients.

Real‐world data reveal unmet clinical needs in insulin treatment in Asian people with type 2 diabetes: the Joint Asia Diabetes Evaluation (JADE) Register

“…We and others have reported that DKD is a major risk factor for hypoglycaemia due to multiple factors including reduced renal gluconeogenesis and drug clearance . Although we did not record the year of insulin initiation in these patients, patients with DKD had over 10 years of diabetes when the use of insulin analogues and basal‐bolus regimen were less popular …”

“…30,31 Although we did not record the year of insulin initiation in these patients, patients with DKD had over 10 years of diabetes when the use of insulin analogues and basal-bolus regimen were less popular. 32,33 In this real-world register, more women reported hypoglycaemia than men, after adjusting for confounders. Despite having similar glycaemic control (mean HbA1c 72 mmol/mol [8.7%]), women had a higher BMI by 0.4 kg/m 2 and a higher weight-adjusted TDD for any insulin regimen compared to men.…”

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

“…Similarly, we considered fixed‐dose combinations as 2 different NIADs, but they have been reported to be associated with greater adherence compared to the combination of separate pills, which may impact the need for treatment intensification in some cases. Moreover, differences between general practitioners and endocrinologists must be taken into account, as specialists are more likely to use insulin therapies (eg, in 8.6% and 1.7%, respectively, of patients with poor glycaemic control) and they tend to initiate insulin treatment sooner than primary care physicians . This probably reflects a referral bias, with specialists managing the most advanced and complex patients and, hence, those with the worst glycaemic control.…”

“…Moreover, differences between general practitioners and endocrinologists must be taken into account, as specialists are more likely to use insulin therapies (eg, in 8.6% and 1.7%, respectively, of patients with poor glycaemic control) 16 and they tend to initiate insulin treatment sooner than primary care physicians. 56 This probably reflects a referral bias, with specialists managing the most advanced and complex patients and, hence, those with the worst glycaemic control. Nevertheless, the SIDIAP database includes prescriptions from both specialists and primary care physicians, with no differentiation of origin.…”

Treatment patterns and clinical characteristics of patients with type 2 diabetes mellitus according to body mass index: findings from an electronic medical records database

“…Diabetes mellitus management using pharmacological treatments has become increasingly complex with the variety of agents and treatment guidelines available 5–7. Despite extensive treatment guidelines and a wide array of treatment options from the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD)7 8 and the National Institute for Health and Care Excellence,9 the proportion of patients with T2D achieving good glucose control has not increased greatly since 2008 10…”