Initial treatment of diabetes in Italy. A nationwide population-based study from of the ARNO Diabetes Observatory.
Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
Blood Glucose
/ drug effects
Child
Child, Preschool
Databases, Factual
Diabetes Mellitus, Type 1
/ blood
Diabetes Mellitus, Type 2
/ blood
Drug Prescriptions
Drug Substitution
/ trends
Drug Therapy, Combination
/ trends
Drug Utilization
/ trends
Female
Humans
Hypoglycemic Agents
/ adverse effects
Infant
Infant, Newborn
Insulin
/ therapeutic use
Italy
/ epidemiology
Male
Metformin
/ therapeutic use
Middle Aged
Practice Patterns, Physicians'
/ trends
Sulfonylurea Compounds
/ therapeutic use
Time Factors
Treatment Outcome
Young Adult
Diabetes mellitus
Glucose lowering medications
Insulin
Oral agents
Treatment
Journal
Nutrition, metabolism, and cardiovascular diseases : NMCD
ISSN: 1590-3729
Titre abrégé: Nutr Metab Cardiovasc Dis
Pays: Netherlands
ID NLM: 9111474
Informations de publication
Date de publication:
26 08 2021
26 08 2021
Historique:
received:
21
04
2021
revised:
24
05
2021
accepted:
03
06
2021
pubmed:
6
7
2021
medline:
6
10
2021
entrez:
5
7
2021
Statut:
ppublish
Résumé
To investigate diabetes treatment initiation and continuation in the next sixth months in newly diagnosed Italian subjects. We analyzed administrative claims of 11,300,750 Italian residents. Subjects with incident diabetes were identified by glucose lowering drug prescriptions, disease-specific co-payment exemptions and hospital discharge codes occurring in 2018 but not in 2017. Incident cases were 65,932 of whom 91.4% received the prescription of a glucose lowering drug. Among the latter, those receiving a prescription of a noninsulin medication but no insulin were 84.8%, those receiving a prescription of insulin only were 9.4%, and those receiving prescriptions of both insulin and noninsulin drugs were 5.8%. Metformin was the most frequently drug initially prescribed in noninsulin treated subjects (~85%) and sulphonylurea receptor (SUR) agonists collectively ranked as second (~13%). Lispro (35%) and glargine (34%) were the most frequently prescribed molecules in subjects who were insulin treated. Differences in prescriptions were found in age categories, with increased use of SUR agonists across decades. In the first six months, as many as 50% of noninsulin treated patients continued with the initial drug, ~15% added a second agent, ~5% switched to another medication, and ~30% discontinued any glucose lowering treatment. These data document that current guidelines are often neglected because prescriptions of SUR agonists as first agent are still quite common and insulin is prescribed more than expected. They point out the urgent need to improve the dissemination and implementations of guidelines in diabetes care.
Sections du résumé
BACKGROUND AND AIMS
To investigate diabetes treatment initiation and continuation in the next sixth months in newly diagnosed Italian subjects.
METHODS AND RESULTS
We analyzed administrative claims of 11,300,750 Italian residents. Subjects with incident diabetes were identified by glucose lowering drug prescriptions, disease-specific co-payment exemptions and hospital discharge codes occurring in 2018 but not in 2017. Incident cases were 65,932 of whom 91.4% received the prescription of a glucose lowering drug. Among the latter, those receiving a prescription of a noninsulin medication but no insulin were 84.8%, those receiving a prescription of insulin only were 9.4%, and those receiving prescriptions of both insulin and noninsulin drugs were 5.8%. Metformin was the most frequently drug initially prescribed in noninsulin treated subjects (~85%) and sulphonylurea receptor (SUR) agonists collectively ranked as second (~13%). Lispro (35%) and glargine (34%) were the most frequently prescribed molecules in subjects who were insulin treated. Differences in prescriptions were found in age categories, with increased use of SUR agonists across decades. In the first six months, as many as 50% of noninsulin treated patients continued with the initial drug, ~15% added a second agent, ~5% switched to another medication, and ~30% discontinued any glucose lowering treatment.
CONCLUSIONS
These data document that current guidelines are often neglected because prescriptions of SUR agonists as first agent are still quite common and insulin is prescribed more than expected. They point out the urgent need to improve the dissemination and implementations of guidelines in diabetes care.
Identifiants
pubmed: 34218990
pii: S0939-4753(21)00283-0
doi: 10.1016/j.numecd.2021.06.006
pii:
doi:
Substances chimiques
Biomarkers
0
Blood Glucose
0
Hypoglycemic Agents
0
Insulin
0
Sulfonylurea Compounds
0
Metformin
9100L32L2N
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2661-2668Informations de copyright
Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest EB received honoraria for participating in advisory boards of Abbott, Astrazeneca, Becton Dickinson, Boehringer Ingelheim, Bristol-Myers Squibb, Bruno Farmaceutici, Daiichi-Sanyo, Janssen, Johnson&Johnson, Lilly, MSD, Mundipharma, Novartis, Novo Nordisk, Roche, Sanofi, Servier, Takeda. GM received honoraria for participating in advisory boards from Pfizer, Gilead, Novartis, Eli Lilly, Mundipharma. GPF received honoraria or lecture fees from Abbott, AstraZeneca, Boehringer, Lilly, MSC, Mundipharma, Novartis, Novonordisk, Sanofi, Servier.pharma, Novartis, Novonordisk, Sanofi, Servier.