The mortality of patients with diabetes mellitus using oral antidiabetic drugs in the Czech Republic decreased over the decade of 2003–2013 and came closer to the population average

Česká verzia

Authors: Jan Brož 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 ; Všeobecná zdravotní pojišťovna České republiky, Praha, ředitel Ing. Zdeněk Kabátek ²; Ústav zdravotnických informací a statistiky České republiky, 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): 14-20
Category: Original Contributions

Summary

Introduction:
Every year official data is published which describes the care of patients with diabetes mellitus in the Czech Republic. An overall number of individuals with diabetes, the number of newly reported cases and the number of patient deaths is always specified. However this data does not allow us to identify the differences in mortality between the individual cohorts of diabetic patients in relation to therapy.

Goal:
Comparison of the mortality development in the periods of 2002–2006 and 2010–2013 in a representative sample of the patient population with type 2 diabetes mellitus using oral antidiabetic drugs, kept in the database of the General Health Insurance Company of the Czech Republic (VZP) which provided health care coverage for 63% of Czech population in 2013.

Methodology:
A retrospective epidemiologic analysis. 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 2002–2008 and 2009–2013. We only selected those patients for the analysis who were treated with oral antidiabetic medicines (in the given year or the preceding years they had a record of treatment with at least one medicine from A10B group, while having no record of treatment with medicines from A10A group within both years). 237 665 individuals met the selected criteria in 2003 and 315 418 individuals in 2013.

Results:
Mortality rates dropped for all age groups (from 2003–2013): for 50–59 year olds by 1.2%-0.7%; in 60–69 year olds by 2.6%-1.6%; for 70–79 year olds by 5.8%-3.5%. In 2013 mortality rates came close to the general population where for the same age groups they reached 0.6%, 1.5% and 3.4% respectively. When expressed in relative terms, the mortality among 50–59 year olds declined by 42% (Czechia by 25%), among 60–69 year olds by 39% (Czechia by 17%) and among 70–79 year olds by 40% (Czechia by 28%) from the year 2003. The decline in mortality among the patients with DM treated with oral antidiabetic medicines was greater in both absolute and relative terms in the period of 2003–2013 than among the general population in the Czech Republic.

Conclusion:
The analysis of mortality among the patients treated with oral antidiabetic medicines, registered in the VZP database, has shown a clearly favourable trend of mortality decline which is faster than among the general population. The fact that mortality among this cohort is getting closer to that among the general population of the corresponding age is a finding of critical importance. There is a justified expectation that mortality, with increasingly extensive utilization of the present therapeutic procedures, will continue to decrease.

Key words:
diabetes mellitus – mortality – oral antidiabetic medication

Zdroje

1. Diabetologie, péče o diabetiky. Dostupné z WWW: <http://www.uzis.cz/category/tematicke-rady/zdravotnicka-statistika/diabetologie-pece-diabetiky>. (poslední přístup 26. 9. 2015)

2. Haffner SM, Lehto S, Rönnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229–234.

3. Yudkin JS, Chaturvedi N. Developing risk stratification charts for diabetic and nondiabetic subjects. Diabet Med 1999; 16(3): 219–227. Erratum in: Diabet Med 1999; 16(11): 972–973.

4. Doporučený postup péče o diabetes mellitus 2. typu – aktualizace 2012. Česká diabetologická společnost. Dostupné z WWW: <http://www.diab.cz/dokumenty/dm2_12.pdf>. (poslední přístup 26. 9. 2015)

5. Kvapil M., Pavlík T, Titman O et al. Kvalita péče pacienty s diabetes mellitus v České republice: Analýza pro rok 2011. In Kvapil M (ed). Diabetologie 2011. Triton: Praha 2011: 261 – 273. ISBN 978–80–7387–461–2.

6. Mezinárodní statistická klasifikace nemocí a přidružených zdravotních problémů – MKN-10. Dostupné z WWW: <http://www.uzis.cz/cz/mkn/index.html>. (poslední přístup 26. 9. 2015)

7. 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)

8. Český statistický úřad. Veřejná databáze. Dostupné z WWW: <https://vdb.czso.cz/vdbvo2/>. (poslední přístup 27. 9. 2015)

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

10. 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.

11. Scirica BM, Bhatt DL, Braunwald E et al. SAVOR-TIMI 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.

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

13. ACCORD Study Group. Gerstein HC, Miller ME, Genuth S et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 2011; 364(9): 818–828.

14. Duckworth W, Abraira C, Moritz T et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129–139.

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

16. Kvapil M, Češka R. Vnitř Lék 2015; 61(11 Suppl 3): 3S5.

17. Janíčková-Žďárská D, Honěk P, Pavel Dušek L et al. Analýza vývoje preskripce metforminu a sulfonylurey v České republice. Vnitř Lék 2015; 61(11 Suppl 3): 3S25–3S29.

18. Holden SE, Barnett AH, Peters JR et al. The incidence of type 2 diabetes in the United Kingdom from 1991 – 2010. Diabetes Obes Metab 2013; 15(9):844–852.

19. Kvapil M, Pavlík T, Klika P et al. Základní analýza údajů o pacientech s diabetes mellitus. 51. diabetologické dny. Luhačovice 2015. Abstrakt přednášky. DMEV 2015; 18(Suppl 1): 21.

20. Collins R, Armitage J, Parish S et al. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361(9374): 2005–2016.

21. Cannon CP, Blazing MA, Giugliano RP et al. IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372(25): 2387–2397.

22. 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.

23. 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.

24. Scirica BM, Bhatt DL, Braunwald E et al. SAVOR-TIMI 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.

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

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

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

28. Gerstein HC, Miller ME, Genuth S et al. ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med; 364(9): 818–828.

29. Duckworth W, Abraira C, Moritz T et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129–139.