title: Comparison of use of diabetic medication and clinical guidelines in four Nordic countries.
abstract: BACKGROUND
  Clinical guidelines form one of the cornerstones for providing high-quality care for patients with diabetes. We compare the national guidelines and the use of glucose lowering medication for type 2 diabetes (T2D) in Denmark, Finland, Norway and Sweden.
  
  
  METHODS
  We compared how guidelines take comprehensive care into consideration, what treatment targets and what antihyperglycemic medication was recommended. The use of glucose-lowering medication was based on the sales of diabetes drugs in these countries.
  
  
  RESULTS
  All guidelines stress the importance of comprehensive diabetes care. Individualized glycemic targets are emphasized especially in the Danish and Finnish guidelines. In 2013, sulfonylureas were the most common second-line treatment after metformin in Denmark, Norway and Sweden; in Finland, this position was taken by DPP-4 inhibitors. Recommended initial insulin type for patients with T2D differs between the four countries. Danish, Norwegian and Swedish guidelines also take economic aspects into account.
  
  
  CONCLUSIONS
  All guidelines stress regular and comprehensive diabetes care. Danish and Finnish guidelines strongly underline the importance of individualized glycemic targets. All guidelines recommend metformin as the initial oral antihyperglycemic drug. In relation to recommended second line drug therapy and initial insulin type for patients with T2D, the guidelines vary largely between the four countries.
authors.affiliation: a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;|b Kotka Health Center , City of Kotka , Finland ;
authors.forename: Saara
authors.initials: S
authors.lastname: Järvinen
authors.affiliation: a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;|c Vantaa Health Center , City of Vantaa , Finland ;
authors.forename: Merja K
authors.initials: MK
authors.lastname: Laine
authors.affiliation: a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;|d Folkhälsan Research Centre , Helsinki , Finland ;|e National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003191:Comprehensive Health Care / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: Comparison; drug; guideline; medication; type 2 diabetes