The association between co-morbidity and the use of antidiabetics or adjunctive cardiovascular medicines in Australian veterans with diabetes.
OBJECTIVE
To examine the association between co-morbidities and the use of antidiabetic medications or adjunctive cardiovascular medicines among Australian veterans with diabetes.


METHODS
data were sourced from the Australian Department of Veterans' Affairs Health Claims database. All veterans aged 65 years and over who were dispensed medicines for diabetes from July to December 2006 were included. Dispensings of antidiabetic and adjunctive cardiovascular medicines over the first six months of 2007 were examined. Log binominal regression models were used to calculate the relative risks of the dispensing of medications for various co-morbidities, taking into account potential confounders.


RESULTS
among the 14,802 veterans who were dispensed medicines for diabetes, 70% had five or more co-morbidities. Patients who had diabetes-related co-morbidities had significantly less dispensing of metformin monotherapy and more dispensing of insulin than those without these conditions. Patients who had cardiovascular disease were more likely to have three or more oral antidiabetics dispensed (RR=1.16, 95% CI: 1.04-1.30), particularly those who had heart failure (RR=1.24, 95% CI: 1.05-1.47). Patients with renal disease were more likely to have glitazones dispensed (RR=1.46, 95% CI: 1.24-1.72). Adjunctive cardiovascular medicines were significantly less likely to be dispensed to those with established heart conditions and non-related co-morbidities, particularly dementia.


CONCLUSIONS
consistent with guideline recommendations, in this cohort more intensive antidiabetic and cardiovascular therapy is used in those with more severe disease as measured by related co-morbidities. Cardiovascular medicines however may be underutilised in those with un-related co-morbidities.
Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia.
Ying
Y
Zhang
Agnes
A
Vitry
Gillian
G
Caughey
Elizabeth E
EE
Roughead
Philip
P
Ryan
Andrew
A
Gilbert
Sepehr
S
Shakib
Robyn
R
McDermott
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001315:Australia / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D048909:Diabetes Complications / Q000188:drug therapy / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D012306:Risk; D014728:Veterans / Q000706:statistics & numerical data; D058014:Veterans Health
D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents