title: Change of initial oral antidiabetic therapy in type 2 diabetic patients.
abstract: OBJECTIVE
  To explore the 'real-life' therapy of type 2 diabetes mellitus with oral antidiabetic drugs (OADs).
  
  
  METHODS
  From the PHARMO Record Linkage System comprising linked drug dispensing and clinical laboratory data from approximately 2.5 million individuals in the Netherlands, among others, new users of OADs were identified in the period 1999-2004. New users, aged 30 years and older, without insulin use before cohort entry date and with at least one year follow-up were included. We determined per initial therapy patient characteristics and first therapy change.
  
  
  RESULTS
  Overall 35,514 patients were included. Metformin and sulfonylureas (SU) were the most frequent initial therapy. Patients on thiazolidinedione (TZD) monotherapy had lower percentages baseline HbA1c >or= 7% compared to patients on metformin and SU. The proportion of patients still on initial therapy after one year ranged from 46% (TZDs) to around 60% (SU). Among patients starting on monotherapy, add-on (15-20%) and discontinuation (16-25%) of therapy occurred most frequently. In patients starting on combination therapy, a switch occurred in 30% of the patients.
  
  
  CONCLUSIONS
  In more than 40% of the patients a change in initial OAD-therapy is already observed in the first year of therapy. Maintaining patients on initial therapy remains a challenge.
authors.affiliation: PHARMO Institute, Utrecht, The Netherlands. arian.plat@pharmo.nl
authors.forename: Arian
authors.initials: A
authors.lastname: Plat
authors.forename: Fernie
authors.initials: F
authors.lastname: Penning-van Beest
authors.forename: Sophia
authors.initials: S
authors.lastname: Kessabi
authors.forename: Martijn
authors.initials: M
authors.lastname: Groot
authors.forename: Ron
authors.initials: R
authors.lastname: Herings
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
references.citation: Diabetes Care. 2002 Nov;25(11):1933-9
references.pmid: 12401735
references.citation: Diabetes Care. 2001 Aug;24(8):1411-5
references.pmid: 11473078
references.citation: Value Health. 2000 Nov-Dec;3(6):417-26
references.pmid: 16464201
references.citation: Drugs. 2005;65(3):385-411
references.pmid: 15669880
references.citation: Lancet. 1998 Sep 12;352(9131):854-65
references.pmid: 9742977
references.citation: Value Health. 2008 Jan-Feb;11(1):44-7
references.pmid: 18237359
references.citation: J Epidemiol Community Health. 1992 Apr;46(2):136-40
references.pmid: 1349911