gms | German Medical Science

Background: Aim of the study was to analyse the pattern of antihyperglycaemic medication of patients with newly diagnosed diabetes during the first seven years.

Materials and Methods: Population: 18.75% sample of a statutory health insurance (AOK) in Hesse, Germany, age 40+ years (about 160,000 persons). Incident patients: 2002/2003 ICD-10 diagnosis E10-E14, O24 (validated cases), two years before neither diabetes diagnosis nor antihyperglycaemic medication. Logistic regression model: Outcome: antihyperglycaemic drug prescription (yes vs. no); influencing factors: sex (male vs. female), age (40-59 and 60-69 vs. 70+ years), co-morbidity (eye, kidney, neurological/peripheral vascular, cardiac, and cerebrovascular diseases (yes vs. no); α=0.05.

Results: Within the first seven years 60.8% of the patients with newly diagnosed diabetes in 2002/2003 started with antihyperglycaemic therapy (56.3% started with non-insulin, 4.1% with insulin and 0.5% with combined therapy). 43.1% of the patients started medication within the first year after diagnosis. Metformin was most commonly prescribed (to 61% of patients starting with non insulin medication during the first seven years), followed by sulfonylureas (36%). The chance of receiving non-insulin medication during the first seven years was significantly higher among younger patients (40-59, 60-69 years) (OR 2.1, 1.7) as well as among patients with eye diseases (OR 2.2) or neurological/peripheral vascular (OR 1.5) diseases. Receiving insulin was positively associated with male sex (OR 1.3), age 40-59 years (OR 2.2) and co-morbidity except cardiac disease (OR 1.4-2.2). In patients starting with non insulin medication and switching to insulin (n=377) the switch on average occurred after 2.8 years of treatment. 16% switched back to non-insulin medication (7% after only one prescription). Comparison of the cohort of patients incident for diabetes in 2002/03 to an equally defined cohort of patients incident in 2010/11 showed that in the second cohort a considerably higher percentage started drug therapy with metformin (87.7% vs. 58.7% of patients starting non-insulin antihyperglycaemic medication during first year since incidence of diabetes).

Conclusion: The UKPDS study published in 1998 argued in favour of metformin and since 2009 it is the official recommended first line drug in Germany. In accordance to the guidelines the percentage of patients starting with metformin considerably increased from about 60% to 90% in the last decade. Our study showed that young age and co-morbidity pushed the start of drug therapy in patients with diabetes forward. The reasons for switching back again to non-insulin therapy, e.g. medical need or patient’s refusal, should be subject of further investigation.