Analysis of the development of metformin and sulfonylurea prescriptions in the Czech Republic

Česká verzia

Authors: Denisa Janíčková-Žďárská ¹; Petr Honěk ²; Ladislav Dušek ^3,4; Tomáš Pavlík ^3,4; Milan Kvapil ¹
Authors place of work: Interní klinika 2. LF UK a FN Motol, Praha, přednosta prof. MUDr. Milan Kvapil, CSc., MBA ¹; Všeobecná zdravotní pojišťovna České republiky, Praha, ředitel Ing. Zdeněk Kabátek ²; Ústav zdravotnických informací a statistiky, Praha, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ³; Institut biostatistiky a analýz MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ⁴
Published in the journal: Vnitř Lék 2015; 61(Suppl 3): 25-29
Category: Original Contributions

Summary

Introduction:
In the Czech Republic, patients with diabetes mellitus (DM) are followed and treated predominantly by specialists (approx. 80% at a specialist diabetology clinic), a minor part by general practitioners (up to 20%). Long-term development of the changes in prescribing metformin and sulfonylurea in the Czech Republic and its concordance with recommended procedures has not been evaluated until now.

Goal:
Comparison of the development of metformin (MET) and sulfonylurea (SU) prescriptions in the period of 2002–2006 with that of 2010–2014 in a representative sample of the patient population with DM kept in the database of the General Health Insurance Company of the Czech Republic (VZP) which provided health care coverage for 63% of Czech Republic population in 2014.

Methodology:
We identified all individuals in the VZP database who had a record of DM diagnosis (E10 – E16 based on ICD 10) or who had any antidiabetic therapy prescribed (ATC group A10) in the periods of 2002–2006 and 2010–2014. A cohort of patients was extracted for analysis, who had an agent from A10 group prescribed at least once in a relevant year (n = 308 962 in 2002; n = 426 695 in 2014). A number of patients was evaluated for each year, who had at least once MET or SU prescribed. The number of patients treated with MET or SU was then expressed as a percentage of all who had any therapy from A10 group prescribed in the year in question.

Results:
Metformin prescriptions have linearly risen from 43% to 77%, while sulfonylurea prescriptions have linearly decreased from 65% to 37%.

Conclusion:
The analysis presents the first evaluation of the development of metformin prescriptions conducted in the Czech Republic and evaluation of its concordance with the recommended procedures for the treatment of DM. The amount of metformin prescribed in the Czech Republic increased from 43% to 77% while the amount of SU prescribed decreased from 65% to 37% between 2002 and 2014. This development and the current ratio between the prescribed amounts of MET and SU demonstrate the implementation of the recommended procedures into practice and prove the high quality of care for patients with DM2T in specialists – diabetologists‘ surgeries.

Key words:
type 2 diabetes mellitus – metformin – sulfonylurea

Zdroje

1. Ústav zdravotnicvkých informací. Dostupné z WWW: <http://www.uzis.cz>.

2. Intensive bloodglucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131): 837–853.

3. Česká diabetologická společnost. Doporučený postup péče o diabetes mellitus 2. typu. Dostupné z WWW: <http://www.diab.cz/dokumenty/dm2_12.pdf>. (poslední přístup 26. 9. 2015)

4. Ústav zdravotnických informací a statistiky ČR. Diabetologie, péče o diabetiky. Dostupné z WWW: <http://www.uzis.cz/category/tematickerady/zdravotnickastatistika/diabetologiepecediabetiky>. (26. 9. 2015)

5. Ústav zdravotnických informaci. Mezinárodní statistická klasifikace nemocí a přidružených zdravotních problémů – MKN10. Dostupné z WWW: <http://www.uzis.cz/cz/mkn/index.html>. (poslední přístup 26. 9. 2015)

6. WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) classification system. Structure and principles. Dostupné z WWW: <http://www.whocc.no/atc/structure_and_principles/>. (poslední přístup 26. 9. 2015)

7. Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patientcentred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015; 58(3): 429–442.

8. Effect of intensive bloodglucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131): 854–865. Erratum in: Lancet 1998; 352(9139):1558.

9. Holman RR, Paul SK, Bethel MA et al. 10year followup of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359(15): 1577–1589.

10. Matthews DR, Cull CA, Stratton IM et al. UK Prospective Diabetes Study (UKPDS) Group. UKPDS 26: Sulphonylurea failure in noninsulindependent diabetic patients over six years. Diabet Med 1998; 15(4): 297–303.

11. Kahn SE, Haffner SM, Heise MA et al. ADOPT Study Group. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006; 355(23): 2427–2443.

12. Schernthaner G, Grimaldi A, Di Mario U et al. GUIDE study: doubleblind comparison of oncedaily gliclazide MR and glimepiride in type 2 diabetic patients. Eur J Clin Invest 2004; 34(8): 535–542.

13. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560–2572.

14. Kvapil, M. Měly by nás zajímat názory občanů na léčbu diabetu? Kazuistiky v diabetologii 2015; 13(1): 4–5.

15. Wang TY, Eguale T, Tamblyn R. Guidelines adherence in the treatment of patients with newly diagnosed type 2 diabetes: a historical cohort comparing the use of metformin in Quebec pre and postCanadian Diabetes Association guidelines. BMC Health Serv Res 2013; 13: 442. Dostupné z DOI: <http://dx.doi.org/10.1186/1472–6963–13–442>.

16. Clemens KK, Shariff S, Liu K et al. Trends in Antihyperglycemic Medication Prescriptions and Hypoglycemia in Older Adults: 2002–2013. PLoS One 2015; 10(9): e0137596. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0137596>.

17. Ekström N, Schiöler L, Svensson AM et al. Effectiveness and safety of metformin in 51 675 patients with type 2 diabetes and different levels of renal function: a cohort study from the Swedish National Diabetes Register. BMJ Open 2012; 2(4): pii: e001076. Dostupné z DOI: <http://dx.doi.org/10.1136/bmjopen2012–001076>.

18. Leal I, Romio SA, Schuemie M et al. Prescribing pattern of glucose lowering drugs in the United Kingdom in the last decade: a focus on the effects of safety warnings about rosiglitazone. Br J Clin Pharmacol 2013; 75(3): 861–868.

19. Piťhová P, Honěk P, Dušek L et al. Incidence amputací u pacientů s diabetes mellitus v České republice 2010–2014. Vnitř Lék 2015; 61(11 Suppl 3): 3S21–3S24.

20. Green JB, Bethel MA, Armstrong PW et al. TECOS Study Group. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2015; 373(3): 232–242.

21. White WB, Cannon CP, Heller SR et al. EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369(14): 1327–1335.

22. Scirica BM, Bhatt DL, Braunwald E et al. SAVORTIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369(14): 1317–1326.

23. ORIGIN Trial Investigators. Gerstein HC, Bosch J, Dagenais GR et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012; 367(4): 319–328.

24. Zinman B, Wanner C, Lachin JM et al. EMPAREG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015. [Epub ahead of print].