Background: Multiple regimens for the pharmacological management of diabetes exist. In Australia, new agents have become available in recent years. We examined temporal trends in prescribing patterns of pharmacotherapy regimens in Australia.
Methods: The EXTEND45 Study links health information on consenting participants of the 45 and Up Study (2006-2009) with administrative health information from the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) (provided by the Department of Human Services), community pathology providers and other routinely collected health information sources. Linkage was performed by the Centre for Health Record Linkage and the Sax Institute (MBS and PBS). We identified a population-based cohort (2006-2014) of people aged ≥45 years who met a pre-specified definition for diabetes. Treatment episodes amongst our cohort were identified, and defined as the period that a patient adhered to a particular regimen of pharmacotherapy without any changes or treatment breaks of two or more standard coverage days (SCD). Episodes were attributed to the calendar year in which they commenced and were categorized into six patterns of glucose lowering medication use.
Results: We identified 24,236 participants with diabetes who experienced 149,532 treatment episodes over a mean follow-up period of 4.97 years. Episodes included: never treated (4.4%), monotherapy (33.1%), dual therapy (17.0%), triple or more therapy (4.0%), insulin-based therapy (21.7%) and treatment break (20.3%). Metformin (a biguanide) accounted for the majority (68.5%) of monotherapy episodes, followed by sulfonlyureas (23.1%). The combination of metformin and a sulfonylurea was the most common dual therapy episode (56.1%) but became less common over the study period (75.5% in 2006 to 41.1% in 2014).
Conclusion: Most treatment episodes in our cohort involved a monotherapy regimen. There was a temporal change in the specific drug agents prescribed in dual therapy regimens, likely related to the availability of newer agents.
T.K. Young: None. C. Hockham: None. L. Sukkar: None. A. Kang: None. M. Jun: Research Support; Self; AstraZeneca. J. Baker: None. K. Rogers: None. A. Cass: None. C.A. Pollock: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Otsuka Pharmaceutical Co., Ltd., Vifor Pharma. Board Member; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Novartis AG, Vifor Pharma. Other Relationship; Self; Janssen Pharmaceuticals, Inc. D. Sullivan: None. G. Wong: None. M.J. Jardine: Advisory Panel; Self; Akebia Therapeutics, Baxter, Boehringer Ingelheim International GmbH, CSL Behring, Vifor Pharma. Research Support; Self; Amgen Inc., Baxter, Eli Lilly and Company, Gambro, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc. Other Relationship; Self; Janssen Pharmaceuticals, Inc.
National Heart Foundation of Australia (100720); Roche Products Pty Ltd. (FR-MIR-0095); Rebecca L. Cooper Grant (REB002); Eli Lilly Australia Pty Ltd. (PO4100294024); Merck Sharp & Dohme Australia Pty Ltd. (MSD_EXTEND45); Amgen Australia Pty Ltd. (Amgen01)