title: Patterns and determinants of new first-line antihyperglycaemic drug use in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  We evaluated the patterns and determinants that influence the selection, timing and duration of first-line antihyperglycaemic drug (AHD) treatment in patients with type 2 diabetes in Germany, focusing specifically on treatment-naive AHD initiators.
  
  
  METHODS
  Pharmacy dispensing claims data were linked with a cohort of patients newly enrolled in a German Disease Management Program for type 2 diabetes (DMP-DM2) between 2003 and 2009. We examined uptake of first-line pharmacotherapy in previously unmedicated patients and identified predictors of receiving AHD therapy in general and metformin in particular using multivariable regression analyses.
  
  
  RESULTS
  There were 27,138 unmedicated patients with type 2 diabetes and 47.0% of them were started on AHD treatment within 5 years after enrollment. Initial severity of diabetes was the major predictor of receiving first-line pharmacotherapy. Metformin accounted for 63% of newly prescribed AHD in 2003 and more than 80% in 2009 while sulfonylureas accounted for only 10%. Initiating metformin as first-line AHD was associated with younger age, higher BMI, lower HbA1c, and shorter diabetes duration (multivariate p<0.001 for all). Therapy switch or step-up was less frequent among metformin initiators than sulfonylurea initiators.
  
  
  CONCLUSIONS
  The majority of patients were not started on AHD therapy within 5 years after enrollment. In line with recent therapy guidelines, current first-line antihyperglycaemic treatment was increasingly based on metformin. AHD initiators started on sulfonylurea were generally more advanced in their disease and were started later on primary pharmacotherapy.
authors.affiliation: Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany. Electronic address: ageier@uni-muenster.de.
authors.forename: A S
authors.initials: AS
authors.lastname: Geier
authors.affiliation: Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Wellmann
authors.affiliation: Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Wellmann
authors.affiliation: Epidemiological Cancer Registry of North Rhine-Westphalia, Münster, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Kajüter
authors.affiliation: Epidemiological Cancer Registry of North Rhine-Westphalia, Münster, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Heidinger
authors.affiliation: Institute of Pharmaceutical and Medical Chemistry, University of Münster, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hempel
authors.affiliation: Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany; Epidemiological Cancer Registry of North Rhine-Westphalia, Münster, Germany.
authors.forename: H W
authors.initials: HW
authors.lastname: Hense
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: Disease management program; Health services research; Pharmacotherapy; Prescription patterns; Type 2 diabetes mellitus