Zusammenfassung
Hintergrund
Menschen mit Diabetes mellitus Typ 2 sind oft von unterschiedlichen Komorbiditäten betroffen, ohne dass aktuell hinreichend repräsentative Daten zum Komorbiditätsstatus sowie zur Medikation dieser Patienten vorliegen.
Ziel
Ziel dieses Beitrags war es, den Komorbiditätsstatus und die medikamentöse Therapie von Menschen mit Diabetes mellitus Typ 2 zu beschreiben sowie die indikationsbezogene Eignung bestimmter Wirkstoffe für ältere Patienten zu analysieren.
Material und Methoden
Die Analysen wurden auf Basis von Daten der AOK Plus der Jahre 2010–2012 durchgeführt. In 5 medikationsbezogenen Subgruppen wurden die 20 häufigsten Komorbiditäten und Dauermedikationen analysiert. Für ältere Patienten ab 65 Jahren wurden die identifizierten Dauermedikationen im Bereich Antidiabetika und Antihypertonika anhand der FORTA-Klassifikation (FORTA: „fit for the aged“) überprüft.
Ergebnisse
Es wurden 403.360 Patienten mit der Diagnose Diabetes mellitus Typ 2 in die finale Auswertung eingeschlossen, wobei der Frauenanteil 55,9 % und das Durchschnittsalter 72,1 Jahre betrugen. Hypertonie mit 91,3 % und Störungen des Lipidstoffwechsels mit 56,6 % Betroffenen waren die am häufigsten identifizierten Komorbiditäten. Äquivalent stellten Antihypertonika den größten Teil der Medikationen mit 93,9 % aller Patienten dar. Jeder 6. betrachtete Patient erhielt zumindest eine aus FORTA-Sicht kritisch zu bewertende Medikation.
Schlussfolgerungen
In der Behandlungsrealität in Deutschland leiden Patienten mit Typ-2-Diabetes unter einer Vielzahl von Komorbiditäten, die im Rahmen einer Multimedikationstherapie behandelt werden. Die Auswahl der Substanzen bei älteren Betroffenen weist erhebliches Optimierungspotenzial auf.
Abstract
Background
Patients with type 2 diabetes mellitus (T2DM) often suffer from several comorbidities. However, there is a scarcity in representative data describing both the comorbidity status and drug therapy of German T2DM patients.
Aim
The main objective of this analysis was to describe comorbidity status and drug-based therapy of patients with T2DM. In addition, the adequacy of the drug therapy for older patients was assessed.
Materials and methods
All analyses were done based on a claims data set provided by AOK Plus; the data set covered the years 2010–2012. In 5 different patient subgroups, as defined by the number of different medications these patients received, we reported the top 20 comorbidities and medications. For older patients aged at least 65 years, we assessed adequacy of medication for antidiabetic and antihypertensive medication based on the FORTA (Fit for the Aged) list.
Results
Included in the final data set were 403,360 patients with T2DM (mean age 72.1 years); 55.9% were women. The most frequently observed comorbidities were hypertension (91.3%) and lipid metabolism disorders (56.6%). In line with that, 93.9% of all T2DM patients received antihypertensive drugs. Based on the FORTA assessment, almost every sixth patient with T2DM, who was at least 65 years old, received a pharmacological treatment that should be avoided in this age group.
Conclusions
In real life, German patients with T2DM suffer from several comorbidities that are treated with different medications. Pharmacological therapy of older patients can be improved in a substantial percentage of patients.
Literatur
Alonso-Moran E, Orueta JF, Esteban JIF, Axpe JMA, Gonzalez MLM, Polanco NT et al (2015) Multimorbidity in people with type 2 diabetes in the Basque Country (Spain): Prevalence, comorbidity clusters and comparison with other chronic patients. Eur J Intern Med 26:197–202
Chae J, Song CS, Kim H, Lee K, Seo B, Kim D (2011) Prediction of mortality in patients undergoing maintenance hemodialysis by Charlson Comorbidity Index using ICD-10 database. Nephron Clin Pract 117:c379–c384
Cho YY, Sidorenkov G, Denig P (2016) Role of patient and practice characteristics in variance of treatment quality in type 2 diabetes between general practices. PLOS ONE 11:e0166012
Doehner W, Erdmann E, Cairns R, Clark AL, Dormandy JA, Ferrannini E et al (2012) Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: an analysis of the PROactive study population. Int J Cardiol 162:20–26
Frölich L, Schwarz S, Wedding U, Wehling M, Burkhardt H (Hrsg) (2013) Arzneitherapie für Ältere, 3. Aufl. Springer, Berlin
Fu H, Curtis BH, Xie W, Festa A, Schuster DP, Kendall DM (2014) Frequency and causes of hospitalization in older compared to younger adults with type 2 diabetes in the United States: a retrospective, claims-based analysis. J Diabetes Complicat 28:477–481
Holstein A, Hammer C, Hahn M, Kulamadayil N, Kovacs P (2010) Severe sulfonylurea-induced hypoglycemia: a problem of uncritical prescription and deficiencies of diabetes care in geriatric patients. Expert Opin Drug Saf 9:675–681
Iglay K, Hannachi H, Howie PJ, Xu J, Li X, Engel SS et al (2016) Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin 32:1243–1252
Kuhn-Thiel AM, Weiss C, Wehling M (2014) Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 31:131–140
Ng E, McGrail KM, Johnson JA (2010) Hospitalization risk in a type 2 diabetes cohort. Health Rep 21:29–35
O’Shea MP, Teeling M, Bennett K (2015) Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population. Ir J Med Sci 184:623–630
Roglic G (2016) Global report on diabetes. World Health Organization, Geneva
Tryggestad JB, Willi SM (2015) Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial. J Diabetes Complicat 29:307–312
Walker J, Halbesma N, Lone N, McAllister D, Weir CJ, Wild SH (2016) Socioeconomic status, comorbidity and mortality in patients with type 2 diabetes mellitus in Scotland 2004–2011: a cohort study. J Epidemiol Community Health 70:596–601
Wehling M (2009) Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc 57:560–561
Wilke T, Ahrendt P, Schwartz D, Linder R, Ahrens S, Verheyen F (2013) Inzidenz und Prävalenz von Diabetes mellitus Typ 2 in Deutschland. Dtsch Med Wochenschr 138:69–75
Wilke T, Groth A, Fuchs A, Seitz L, Kienhofer J, Lundershausen R et al (2014) Real life treatment of diabetes mellitus type 2 patients: an analysis based on a large sample of 394,828 German patients. Diabetes Res Clin Pract 106:275–285
Wilke T, Mueller S, Groth A, Fuchs A, Seitz L, Kienhofer J et al (2015) Treatment-dependent and treatment-independent risk factors associated with the risk of diabetes-related events: a retrospective analysis based on 229,042 patients with type 2 diabetes mellitus. Cardiovasc Diabetol 14:14
Yang X, Ma RC, So W, Kong AP, Ko GT, Ho C et al (2008) Development and validation of a risk score for hospitalization for heart failure in patients with Type 2 diabetes mellitus. Cardiovasc Diabetol 7:9
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T. Wilke, P. Hahn, A. Groth, A. Fuchs und U. Maywald geben an, dass kein Interessenkonflikt besteht. T. Wilke, A. Groth und P. Hahn sind für das Institut IPAM tätig; A. Fuchs und U. Maywald arbeiten für die AOK Plus.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Wilke, T., Hahn, P., Groth, A. et al. Arzneimitteltherapie multimorbider Typ-2-Diabetes-Patienten. Diabetologe 13, 108–114 (2017). https://doi.org/10.1007/s11428-016-0183-5
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DOI: https://doi.org/10.1007/s11428-016-0183-5
Schlüsselwörter
- Glukoseintoleranz
- Hyperglykämie
- Pharmakologische Therapie
- Medikamentenwechselwirkungen
- Potenziell inadäquate Medikation