Trends and influences on use of antidiabetic drugs in England, 1992-2003.
OBJECTIVE
To describe trends in prescribing for glycaemic control in diabetes mellitus in England, 1993-2003, and to examine the effects of new clinical evidence or national guidance on these.


METHODS
Observational study of prescribing adjusted for extrapolated changes in epidemiology of insulin and non-insulin treated diabetes.


METHODS
Primary care in England, 1992-2003.


METHODS
Three monthly prescribing data from the Prescription Pricing Authority.


METHODS
Defined daily doses/patient/quarter of oral hypoglycaemics and of insulin.


RESULTS
There was an increase in the prevalence of both insulin treated (85%) and non-insulin treated (80%) diabetes. There were increases in all drug use, which were largely explained by this: for example, sulphonylurea use increased by 101% in total but only 11% after correction for change in prevalence and population; insulin use increased by 140% in total, but 33% after correction. Neither guidances from the National Institute of Clinical Excellence nor new clinical evidence had any discernible effect on this. An exception was metformin use, which increased by 495% in total, and by 277% after correction. This increase occurred mainly from early 1998 and seemed to coincide with the publication of evidence of the specific benefits of metformin.


CONCLUSIONS
There has been a trend towards more aggressive treatment of diabetes. National guidance may have reinforced this but has not altered the trend. Specific evidence around metformin may have been very influential in increasing its use.
Walley
Tom
T
Department of Pharmacology and Therapeutics, University of Liverpool, 70 Pembroke Place, Liverpool, UK. twalley@liv.ac.uk
Hughes
Dyfrig
D
Kendall
Helen
H
D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D017723:Drug Utilization Review / Q000639:trends*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D015995:Prevalence
D007004:Hypoglycemic Agents; D007328:Insulin