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A retrospective cohort analysis of hypoglycaemic and cardiovascular agent use in young adults in the Irish primary care setting

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Abstract

Aim

The prevalence of type 2 diabetes in young adults is increasing, yet little is known about medication use in this population. This study aimed to describe hypoglycaemic and cardiovascular treatment patterns in young adults newly treated with oral hypoglycaemic agents.

Methods

A retrospective cohort study from 2008–2011 was conducted using the Irish national pharmacy claims database. Subjects aged 15–39 years were analysed for use of hypoglycaemic therapy, subsequent regimen changes, and any co-prescription of cardiovascular agents 1 year after treatment initiation. Cox-proportional-hazards regression and logistic regression were used to examine factors associated with non-persistence to initial hypoglycaemic therapy (in males only), insulin use as a regimen change, and use of cardiovascular agents. Hazard ratios (HR), odds ratios (OR), and 95 % confidence intervals (CI) are presented.

Results

There were 5284 individuals initiated on hypoglycaemic agents. Most were initiated on metformin (88 %); 13 % of subjects received a hypoglycaemic agent regimen change, with insulin being used in 26 % of these cases. A total of 38 % of males were non-persistent with their initial hypoglycaemic agent, with males aged 15–29 years and those on sulphonylureas significantly more likely to be non-persistent with therapy. Over 40 % of subjects were initiated on cardiovascular agents. Females were less likely to receive cardiovascular agents [OR 0.50 (95 % CI 0.42–0.83)].

Conclusions

Treatment patterns were found to be associated with high levels of non-persistence, substantial use of insulin, and a low use of cardiovascular agents. This may pose problems for the management of the long-term complications associated with type 2 diabetes.

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Acknowledgments

R. G. would like to thank the School of Pharmacy and Pharmaceutical Sciences for the award of a Trinity College Dublin postgraduate research studentship. This work was conducted as part of the HRB Ph.D. Scholars Programme in Health Services Research Grant No. PHD/2007/16. We also thank the HSE- Primary Care Reimbursement Service for providing the data on which the study was based.

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Authors and Affiliations

  1. School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland

    R. T. Grimes & M. C. Henman

  2. Population Health Division, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland

    K. Bennett

  3. Department of Paediatrics, Trinity College Dublin, Dublin, Ireland

    H. Hoey

  4. National Centre for Pharmacoeconomics, St. James’s Hospital, Dublin 8, Ireland

    L. Tilson

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  1. R. T. Grimes
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  2. K. Bennett
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  3. H. Hoey
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  4. L. Tilson
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  5. M. C. Henman
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Correspondence to R. T. Grimes.

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All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities could appear to have influenced the submitted work.

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Grimes, R.T., Bennett, K., Hoey, H. et al. A retrospective cohort analysis of hypoglycaemic and cardiovascular agent use in young adults in the Irish primary care setting. Ir J Med Sci 186, 461–470 (2017). https://doi.org/10.1007/s11845-016-1491-x

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  • DOI: https://doi.org/10.1007/s11845-016-1491-x

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