Summary
A questionnaire survey was carried out to explore differences in the approach to treatment of patients with Type II diabetes between physicians in Northern Ireland, Norway and Sweden, and to discover to what extent it could account for the three-fold difference in drug use between the countries. A representative sample of 400 physicians in each country was asked to give their opinions on the choice of therapy for three model cases designed to cover the spectrum of treatment — from diet alone to insulin. Significantly more Swedish (65%) than Northern Irish (51%) and Norwegian (52%) doctors suggested diet alone for uncomplicated diabetes recently discovered in a middle aged, overweight man. For symptomatic diabetes in a 76 year old overweight woman with few retinal microaneurysms, the majority of physicians in all three countries suggested treatment with sulphonylureas. Biguanides were here a more common alternative in Northern Ireland than in Scandinavia. For suspected secondary treatment failure in a 63 year old woman with no signs of complications, insulin was suggested by 71% of the Norwegian doctors but only by 44 and 49% of those in Northern Ireland and Sweden, respectively. General practitioners tended to suggest oral treatment earlier and to maintain it longer than hospital physicians. The study has demonstrated significant differences in the approach to treatment of Type II diabetes mellitus between physicians in the three countries. However, the differences were more prominent in the choice of drugs than in the threshold of drug treatment. The results also fit with qualitative but not with quantitative differences in drug sales between the countries, suggesting that important differences may exist in the prevalence of clinically recognized Type II diabetes.
Similar content being viewed by others
References
Bergman U, Elmes P, Halse M, Halvorsen T, Hood M, Lunde PKM, Sjöqvist F, Wade OL, Westerholm B (1975) The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden. Eur J Clin Pharmacol 8: 83–89
Baksaas I (1984) Patterns in drug utilization — national and international aspects: Antihypertensive drugs. Acta Med Scand 683 [Suppl]: 59–66
Grimsson A, Idänpään-Heikkilä J, Lunde PKM, Olafsson O, Westerholm B (1977) Förbrukningen av psykofarmaka i Finland, Island, Norge och Sverige. Nord Med 92: 49–54
King DJ, Griffiths K (1984) Patterns in drug utilization — national and international aspects: Psychoactive drugs 1966–80. Acta Med Scand 683 [Suppl]: 71–77
Nordic Council on Medicines (1979) Nordic statistics on medicines 1975–1977. Statistical reports of the Nordic countries. Helsingfors, Oslo, pp 35–36
Nordic Council on Medicines (1982) Nordic statistics on medicine 1978–1980. NLN Publication no. 8–9, Uppsala
WHO Drug Utilization Research Group (DURG) (1985) Validation of observed differences in the utilization of antihypertensive and antidiabetic drugs in Northern Ireland, Norway and Sweden. Eur J Clin Pharmacol 29: 1–8
WHO Drug Utilization Research Group (DURG) (1986) Therapeutic traditions in Northern Ireland, Norway and Sweden: II Hypertension. Eur J Clin Pharmacol 30: 521–525
Yeomans KA (1976) Applied statistics, statistics for the social scientist: 2. Penguin education, Penguin Books, Harmondsworth, Middlesex, England, pp 51–53 and 94–97
Frey H (1971) Om behandling med orale antidiabetika. Tidsskr Nor Laegeforen 91: 1555–1558
Round-table discussion on diabetes therapy (1976) Astonishing differences in the choise of treatment. Too little diet, too much tablets? (in Swedish). Nord Med 91: 171–181
Clarke BF, Campbell IW (1977) Comparison of metformin and chlorpropamide in non-obese, maturity-onset diabetics uncontrolled by diet. Br Med J 2: 1576–1578
Hermann LS (1979) Metformin: A review of its pharmacological properties and therapeutic use. Diabete Metab 5: 233–245
Lord JM, White SI, Bailey CJ, Atkins TW, Fletcher RF, Taylor KG (1983) Effect of metformin on insulin receptor binding and glycaemic control in type II diabetes. Br Med J 286: 830–832
Samarbeidskomitéen for Legemiddelsinformasion. Antidiabetika (1974) Sammandrag, preparatöversikt, Norske kommentarer. Socialstyrelsens kommitté för läkemedelsinformation. 2
Christau B, Åkerblom H, Joner G, Dahlquist G, Ludvigsson J, Nerup J (1981) Incidence of childhood insulin — dependent diabetes mellitus in Denmark, Finland, Norway and Sweden. Acta Endocrinol 98 [Suppl 2]: 68–77
Faber O, Groop L, Melander A (eds) (1984) Diabetes mellitus type II proceedings of a symposium. Acta Endocrinologica 262 [Suppl]: 6
Idman L, Bergman U, Dahlén M, Martinsson L, Wessling A (1985) Gotlandsstudie: Hög förskrivning av diabetesmedel men även hög morbiditet. Läkartidningen 82: 1051–1054
Staff AC, Baksaas I (1985) Bruk av antidiabetika i Norge. Norsk Farmaceutisk Tidskrift 93: 504–509
Multi-centre study (1983) UK Prospective study of therapies of maturity-onset diabetes. I Effect of diet, sulphonylurea, insulin or biguanide therapy on fasting plasma glucose and body weight over one year. Diabetologia 24: 404–411
Author information
Authors and Affiliations
Consortia
Rights and permissions
About this article
Cite this article
WHO Drug Utilization Research Group (DURG)., Griffiths, K., McDevitt, D.G. et al. Therapeutic traditions in Northern Ireland, Norway and Sweden: I. Diabetes. Eur J Clin Pharmacol 30, 513–519 (1986). https://doi.org/10.1007/BF00542408
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00542408