Utilization of antidiabetic drugs in the island of gotland, sweden: Agreement between wholesale figures and prescription data

Summary

In a comparison of three European countries Sweden utilized more antidiabetic drugs than Northern Ireland and Norway. Swedish wholesale figures for a quarter of a year used for the comparison were based on “daily doses”/1000 inhabitants/day. In order to validate the Swedish figures, a defined geographical area was investigated in 1972–1973, the island of Gotland with 54000 inhabitants. Antidiabetic drugs distributed on a wholesale basis were compared with those distributed on a prescription basis. Additional information was gathered (interviews, questionnaires, hospital records etc.) from a sample of patients (n=54) and their prescribing doctors (n=37). There was good agreement between the wholesale and prescription figures for oral antidiabetic drugs over a three month period (30.0 vs 29.8 “daily doses”/1000 inhabitants/day), but this did not apply to insulin (5.9 vs 7.2) unless a longer time period was studied. The average daily doses prescribed were higher than the theoretically derived “daily doses”. Combination antidiabetic drug therapy was preseribed for 28% of the patients. Thirteen different oral antidiabetics were issued during the study period, four of which constituted 90% of the total. Phenformin, the second most commonly prescribed oral antidiabetic drug was prescribed by 33 doctors, and metformin was prescribed by only 14 doctors. Few patients were treated with diet alone and few doctors could obtain assistance from a dietician. There was little or no evidence that patients failed to comply with the prescriptions, but by contrast they adhered poorly to written dietary instructions.