Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation‐wide population‐based study from Taiwan

• Published in: Journal of diabetes Vol. 9; no. 3; pp. 256 - 266
• Main Authors: Ou, Huang‐Tz, Chang, Kai‐Cheng, Liu, Ya‐Ming, Wu, Jin‐Shang
• Format: Journal Article
• Language: English
• Published: Australia 01.03.2017
• Subjects: antidiabetic drug; Asian Continental Ancestry Group; Blood Glucose - metabolism; Chinese; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - ethnology; dipeptidyl peptidase‐4 inhibitors; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Drug Therapy - statistics & numerical data; Drug Therapy - trends; Humans; Hypoglycemic Agents - therapeutic use; Metformin - therapeutic use; Population Surveillance - methods; Sulfonylurea Compounds - therapeutic use; Taiwan; type 2 diabetes; 糖尿病用药,中国人,二肽基肽酶‐4抑制剂,2型糖尿病; antidiabetic drug; dipeptidyl peptidase-4 inhibitors; Chinese; type 2 diabetes; 糖尿病用药,中国人,二肽基肽酶-4抑制剂,2型糖尿病
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12408

Background Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase‐4 inhibitors [DPP‐4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP‐4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs. Methods Cases of type 2 diabetes were derived from Taiwan's National Health Insurance Research Database. Antidiabetic drug use was measured in terms of total quantity of drug exposure and healthcare spending in each calendar year from 2008 to 2103. Multiple logistic regression analysis was used to assess factors associated with drug choice. Results The use of and healthcare spending on DPP‐4i increased significantly from 2008 to 2013, whereas healthcare spending on sulfonylureas decreased. For monotherapy, sulfonylureas were the most common alternatives to metformin, whereas in dual and triple antidiabetic therapies, a DPP‐4i was the most common alternative to initial regimens. The use of a DPP‐4i was positively associated with the use of beta‐blockers, angiotensin II‐converting enzyme inhibitors and/or angiotensin receptor blockers, and lipid‐lowering agents, but negatively correlated with age, hypertension, severity of diabetes complications, and the use of diuretics and calcium channel blockers. Conclusions With growing spending on newer antidiabetic drugs, future research on the comparative cost‐effectiveness and safety of antidiabetic drugs is anticipated. 背景: 目前其他国家的研究已经显示,随着新型糖尿病药品的上市(例如:二肽基肽酶‐4抑制剂[dipeptidyl peptidase‐4 inhibitors,DPP‐4i]),糖尿病的用药情形有显著改变。而目前在台湾,尤其在新型的药品上市之后(如DPP‐4i),目前尚无糖尿病用药相关的处方型态分析。因此,本研究的目标是分析:(1)近年来糖尿病药品的处方型态与花费,(2)在新型药品上市之后,糖尿病药品处方型态的改变,(3)探讨影响选择新旧的糖尿病药品之因子。 方法: 撷取台湾全民健康保险数据库之第二型糖尿病患者。在2008至2013年间,计算每年糖尿病药品的使用量与花费。利用多变相逻辑式回归来分析影响选择新旧糖尿病药品之因子。 结果: 在2008至2013年间,DPP‐4i的使用与花费逐年明显地上升,但磺脲类药品的花费却明显减少。在使用单一糖尿病药品治疗的患者中,磺脲类药品是最常用来替代二甲双胍的药品,但在需要以两种或三种糖尿病药品治疗的患者中,DPP‐4i是最常用来替代其他二线或三线药品的治疗。DPP‐4i的使用与β阻断剂,血管紧张素II转换酶抑制剂和/或血管紧张素受体阻断剂,以及降血脂药品呈正相关,但与年龄、高血压、糖尿病疾病严重程度、利尿剂、钙离子通道阻断剂呈负相关。 结论: 随着新型糖尿病用药的花费逐渐上升,未来比较新旧糖尿病药品的成本、效益与安全性的研究是必要的。 Highlights Healthcare costs spent on dipeptidyl peptidase‐4 inhibitor (DPP‐4i) increased significantly during 2008–13. 3 DPP‐4i was the most commonly used as 2nd and 3rd line antidiabetic treatment. DPP‐4i use was associated with patients' comorbidities (i.e., more coronary artery diseases, less heart failure) and comedications (i.e., more ß‐blockers, less diuretics). Proportion of (a) total number of antidiabetic drug prescriptions (drug quantity adjusted using the defined daily dose) and (b) total cost of antidiabetic drug prescriptions. Sulfonylurea use slightly dropped over time and the share of healthcare spending on sulfonylureas decreased significantly over time (P < 0.01). Dipeptidyl peptidase‐4 inhibitor (DPP‐4i) use increased significantly over time (P < 0.05), becoming one of the top three oral antidiabetic drugs in 2013. Healthcare spending on DPP‐4i has increased significantly (P < 0.001), with it being the top antidiabetic medication in terms of healthcare spending in 2013. GLP‐1RA, glucagon‐like peptide‐1 receptor agonists; TZD, thiazolidinedione.