Abstract
Background
Over the last decade there have been significant changes in the prescribing of antidiabetic therapies. It is of interest to know about these trends and variations in the Irish population so that future prescribing patterns can be estimated.
Aims
To examine the trends in prescribed antidiabetic treatments, including variations across age, gender, socioeconomic status and regions in the Irish population over the last 10 years.
Methods
The Irish national pharmacy claims database was used to identify patients ≥16 years dispensed antidiabetic agents (oral or insulin) from January 2003 to December 2012 through the two main community drug schemes for diabetes. The rate of prescribing per 1,000 population was calculated. Logistic regression was used to examine variations in prescribing in patients with diabetes.
Results
There was a significant increase in the prescribing of fast and long-acting insulin analogues with a rapid decline in the prescribing of human insulin (p < 0.0001). Increased prescribing of metformin, incretin modulators and fixed oral combination agents was observed (p < 0.0001). Females and older aged patients were more likely to be prescribed human insulin than other insulins. Metformin was less likely while sulphonylureas were more likely to be prescribed in older than younger aged patients. Socioeconomic differences were observed in increased prescribing of the newer and more expensive antidiabetic agents in the non-means tested scheme. Regional variations were observed in the prescribing of both insulin and oral antidiabetic agents.
Conclusion
There has been an increase over time in the prescribing of both insulin and oral antidiabetic agents in the Irish population with increasing uptake of newer antidiabetic agents. This has implications for projecting future uptake and expenditure of these agents given the rising level of diabetes in the population.
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References
Belanda K, Barron S, Fahy L, McLaughlin A (2010) Making Chronic Conditions Count: Hypertension, Stroke, Coronary Heart Disease. Institute of Public Health in Ireland, Diabetes. A systematic approach to estimating and forecasting population prevalence on the island of Ireland. Dublin
Health Service Executive (2005) Finance Shared Services Primary Care Reimbursement Services Statistical Analysis of Claims and Payments 2005. Health Service Executive, Dublin
Health Service Executive (2009) Finance Shared Services Primary Care Reimbursement Services Statistical Analysis of Claims and Payments 2009. Health Service Executive, Dublin
Nolan J, O’Halloran D, McKenna T, Firth R, Redmond S (2006) The cost of treating Type 2 Diabetes (CODEIRE). Ir Med J 99:307–310
Olsson J, Lindberg G, Gottsater M (2001) Differences in pharmacotherapy and in glucose control of type 2 diabetes patients in two neighbouring towns: a longitudinal population-based study. Diabetes Obes Metab 3:249–253
Willert T, Walker J, Schramm W (2012) Regional analysis of drug treatment prevalence and medication of diabetes mellitus in Germany [Article in German]. Dtsch Med Wochenschr 137:2363–2368
Usher C, Creed L, Bennett K, Feely J (2006) Prescribing for patients with diabetes in the community drug schemes. Ir Med J 99:181–183
Usher C, Bennett K, Feely J (2005) Regional variation in the prescribing for diabetes and use of secondary preventative therapies in Ireland. Pharmacoepidemiol Drug Saf 14:537–544
WHO collaborating centre for drug statistics methodology (2008) http://www.whocc.no/ddd/. WHO collaborating centre for drug statistics methodology. Oslo: Norwegian Institute of Public Health
Central Statistics Office (2003) Volume 1— Population Classified by Area. Government of Ireland, Dublin
Central Statistics Office (2012) Population by Area. Government of Ireland, Dublin
Filion KB, Joseph L, Boivin J-F, Suissa S, Brophy JM (2009) Trends in the prescription of anti-diabetic medications in the United Kingdom: a population-based analysis. Pharmacoepidemiol Drug Saf 18:973–976
Baviera M, Monesi L, Marzona I, Avanzini F, Monesi G et al (2011) Trends in drug prescriptions to diabetic patients from 2000 to 2008 in Italy’s Lombardy Region: a large population-based study. Diabetes Res Clin Pract 93:123–130
Melander A, Folino-Gallo P, Walley T, Schwabe U, Groop P et al (2006) Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels. Diabetologia 49:2024–2029
Siebenhofer A, Plank J, Berghold A, Jeitler K, Horvath K, et al (2006) Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev 2
Casson I, Clarke C, Howard C, McKendrick O, Pennycook S et al (1997) Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ 315:275–278
Torlone E, Di Cianni G, Mannino D, Lapolla A (2009) Insulin analogs and pregnancy: an update. Acta Diabetol 46:163–172
Neumiller J, Setter S (2009) Pharmacologic management of the older patient with type 2 diabetes mellitus. Am J Geriatr Pharmacother 7:324–342
Amiel S, Dixon T, Mann R, Jameson K (2008) Hypoglycaemia in Type 2 diabetes. Diabet Med 25:245–254
Millett C, Saxena S, Ng A (2007) Socio-economic status, ethnicity and diabetes management: an analysis of time trends using the health survey for England. J Public Health (Oxf) 4:413–419
Wild S, McKnight J, McConnachie A, Lindsay R, On behalf of the Glasgow and Lothian Diabetes Register Data Group (2010) Socioeconomic status and diabetes-related hospital admissions: a cross-sectional study of people with diagnosed diabetes. J Epidemiol Community Health 64:1022–1024
Saydah S, Lochner K (2010) Socioeconomic status and risk of diabetes-related mortality in the U.S. Public Health Rep 125:377–388
Booth G, Hux J (2003) Relationship between avoidable hospitalizations for diabetes mellitus and income level. Arch Intern Med 163:101–106
Chaturvedi N, Jarrett J, Shipley M (1998) Socio-economic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes. BMJ 316:100–105
Rabi D, Edwards A, Southern D (2006) Association of socio-economic status with diabetes prevalence and utilization of diabetes care services. BMC Health Serv Res 6:124
Guimaraes C, Marra C, Colley L, Gill S, Simpson S et al (2009) Socioeconomic differences in preferences and willingness-to-pay for insulin delivery systems in type 1 and type 2 diabetes. Diabetes Technol Ther 11:567–573
Rungby J, Krentz A (2007) Pharmacoepidemiology of diabetes. In: Mogensen C (ed) Pharmacotherapy of diabetes: new developments. Springer, New York
Strickland-Hodge B, Jegson M (1980) Usage of information sources by general practitioners. J R Soc Med 73:857–862
Jones M, Greenfield S, Bradley C (2001) Prescribing new drugs: qualitative study of influences on consultants and general practitioners. BMJ 323:378–381
Brennan C, Harkins V, Perry I (2008) Management of diabetes in primary care: A structured-care approach. Eur J Gen Pract 14:117–122
Patel H, Srishanmuganathan J, Car J, Majeed A (2007) Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991–2004. J Public Health (Oxf) 29:48–52
Acknowledgments
We would like to thank the HSE-PCRS for providing us with the database on which this study was based. Special thanks to the late Professor John Feely for his ideas and contributions to this work. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Zaharan, N.L., Williams, D. & Bennett, K. Prescribing of antidiabetic therapies in Ireland: 10-year trends 2003–2012. Ir J Med Sci 183, 311–318 (2014). https://doi.org/10.1007/s11845-013-1011-1
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DOI: https://doi.org/10.1007/s11845-013-1011-1