Cardiovascular drug use prior to diagnosis of diabetes: a pilot study in community pharmacy.
OBJECTIVE
The literature indicates that cardiovascular drug use is higher during the years prior to diagnosis of type 2 diabetes mellitus. As there are pharmaco-epidemiological and economic consequences of enhanced medication use prior to diagnosis of diabetes, there is a need for a comparative analysis of the drug-use pattern by patients with a subsequent diagnosis of diabetes and control patients. This pilot study aimed to investigate cardiovascular drug use in patients with a subsequent diagnosis of diabetes using data extracted from 200 community pharmacies in the Belgian township of Hasselt.


METHODS
Based on community pharmacy data, a retrospective case-control study compared the drug use of patients with a subsequent diagnosis of type 2 diabetes (cases) with patients without a subsequent diagnosis (controls). Cases were identified if patients started taking metformin (and possibly other drugs used in diabetes) during the 2004-2006 study period. Drug use was expressed as a binary variable, reflecting whether or not a patient took drugs belonging to a specific cardiovascular subclass.


RESULTS
Our dataset consisted of 158 cases with a subsequent diagnosis of type 2 diabetes and 632 control patients. Patients with a subsequent diagnosis of type 2 diabetes had a higher propensity to take cardiovascular drugs prior to diagnosis than control patients. This trend was observed across all cardiovascular drug classes, except for calcium-channel blockers, and was statistically significant for beta-blocking agents and agents acting on the renin-angiotensin system.


CONCLUSIONS
A positive association was observed between cardiovascular drug use and subsequent diagnosis of type 2 diabetes. This study emphasizes the potential role for community pharmacy in early identification of diabetes using more targeted screening based on cardiovascular drug use as derived from pharmacy databases.
Simoens
Steven
S
Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. steven.simoens@pharm.kuleuven.be
De Coster
Sandra
S
Dethier
Marleen
M
Lenie
Jan
J
Meuwissen
Paul
P
Laekeman
Gert
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001530:Belgium; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016022:Case-Control Studies; D003157:Community Pharmacy Services / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D012084:Renin-Angiotensin System / Q000187:drug effects; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D002317:Cardiovascular Agents