Universität zu Köln

Lappe, Veronika, Koester, Ingrid and Schubert, Ingrid (2017). Anti-Diabetic Medication During the First Four Years of Treatment. A Study Based on Claims Data. Dtsch. Med. Wochenschr., 142 (1). S. E1 - 9. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-4413

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Abstract

Background Ever since the UKPDS study reassessed the usefulness of the substance metformin in 1998, it has been the first-line medication in anti-diabetic treatment. In addition, new classes and agents released on the market have given rise to new treatment options. The present study investigates prescription practice at the onset of treatment and in the years thereafter and measures it against German diabetes guidelines. Database and Methods Database: Statutory health insurance sample AOK/KV Hesse; Ages: 40 and over (N = 142514). Study population: New users of anti-diabetic medication in 2008 (no medication during the preceding 730 days) (n = 1882). Investigation of anti-diabetic medication for four years after initial prescription with regard to substance spectrum, combination treatments, changes in treatment. Log-binomial model: factors influences onset of treatment with metformin versus sulfonylureas (age, sex, duration of illness, comorbidity). Results In 2008 67.9 % of patients began treatment exclusively with metformin, 17.8 % exclusively with sulfonylureas, and 6.7 % exclusively with insulin. Patients diagnosed as obese were significantly more likely to receive metformin. Elderly (80 years and over) or who had been diagnosed with diabetes at least three years prior or patients with renal or cerebrovascular illnesses were significantly less likely to receive metformin. Over the course of treatment, the number of patients receiving multiple medications increased from 5 % to 30 %. (The most frequent combinations were metformin/DPP4 inhibitor, metformin/sulfonylureas, and metformin/insulin.) Conclusion The findings show that German patient care guidelines on diabetes are reflected in prescription practice. Renal diseases are taken into account as potential contraindications for metformin treatment. In the wake of the expansion of approval for metformin in 2015 - reducing the creatinine clearance level to which application is possible - this first-line medication will be available for an ever larger circle of patients in the future.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lappe, Veronika UNSPECIFIED UNSPECIFIED UNSPECIFIED Koester, Ingrid UNSPECIFIED UNSPECIFIED UNSPECIFIED Schubert, Ingrid UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-246740
DOI:	10.1055/s-0042-120111
Journal or Publication Title:	Dtsch. Med. Wochenschr.
Volume:	142
Number:	1
Page Range:	S. E1 - 9
Date:	2017
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-4413
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DIABETES-MELLITUS; RISK RATIOS; HYPERGLYCEMIA; INITIATION; PATTERNS; THERAPY; COHORT; CODIM Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24674