Do guidelines matter? A population-based study of diabetes drug use during 20 years.
OBJECTIVE
To analyse diabetes drug use in a defined population during 20 years in relation to recommendations in published guidelines.


METHODS
From the Tierp Study Database, all medical records for diabetes patients at the primary health care centre in Tierp municipality and all prescriptions for diabetes drugs at the local pharmacies during the period 1975-1994 were collected. Data for 2125 persons were obtained, generating 13,190 person-years of observation.


METHODS
Tierp primary health care district.


METHODS
Diabetes treatment.


RESULTS
The annual prevalence of diabetes mellitus increased from 2.8% (565 patients) to 3.8% (734 patients). When guidelines emphasised diet treatment, treatment with diet only increased and oral pharmacological treatment decreased. When guidelines emphasised better glycaemic control, diet only decreased and biguanide treatment increased, and when guidelines emphasised vigorous glycaemic control, treatment with diet only decreased further and sulphonylurea and insulin use increased. The substantial age and sex differences in antidiabetic drug use at the beginning of the period were partly reduced over time.


CONCLUSIONS
The considerable changes in antidiabetic drug use during the study period coincided with changes in the guidelines issued. The age and sex differences in drug use became less pronounced towards the end of the period.
Stålhammar
J
J
Department of Public Health and Caring Sciences, Uppsala University, Sweden.
Berne
C
C
Svärdsudd
K
K
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001645:Biguanides / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000178:diet therapy / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D017678:Sex Distribution; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
D001645:Biguanides; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds