title: Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position.
abstract: BACKGROUND
  Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.
  
  
  METHODS
  We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
  
  
  RESULTS
  The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
  
  
  CONCLUSIONS
  We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Claessen
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Ina-Maria
authors.initials: IM
authors.lastname: Rückert
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Schunk
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Thorand
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Narres
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Noreen
authors.initials: N
authors.lastname: Pundt
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Krone
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Slomiany
authors.affiliation: Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany; Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D005858:Germany; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000191:economics; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D012959:Socioeconomic Factors
chemical_list: D007004:Hypoglycemic Agents