title: Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation-wide population-based study from Taiwan.
abstract: BACKGROUND
  Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase-4 inhibitors [DPP-4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP-4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.
  
  
  METHODS
  Cases of type 2 diabetes were derived from Taiwan's National Health Insurance Research Database. Antidiabetic drug use was measured in terms of total quantity of drug exposure and healthcare spending in each calendar year from 2008 to 2103. Multiple logistic regression analysis was used to assess factors associated with drug choice.
  
  
  RESULTS
  The use of and healthcare spending on DPP-4i increased significantly from 2008 to 2013, whereas healthcare spending on sulfonylureas decreased. For monotherapy, sulfonylureas were the most common alternatives to metformin, whereas in dual and triple antidiabetic therapies, a DPP-4i was the most common alternative to initial regimens. The use of a DPP-4i was positively associated with the use of beta-blockers, angiotensin II-converting enzyme inhibitors and/or angiotensin receptor blockers, and lipid-lowering agents, but negatively correlated with age, hypertension, severity of diabetes complications, and the use of diuretics and calcium channel blockers.
  
  
  CONCLUSIONS
  With growing spending on newer antidiabetic drugs, future research on the comparative cost-effectiveness and safety of antidiabetic drugs is anticipated.
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Huang-Tz
authors.initials: HT
authors.lastname: Ou
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Kai-Cheng
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Department of Family Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Ya-Ming
authors.initials: YM
authors.lastname: Liu
authors.affiliation: Department of Economics, School of Social Sciences, National Cheng Kung University, Tainan, Taiwan.|Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jin-Shang
authors.initials: JS
authors.lastname: Wu
mesh_terms: D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D004358:Drug Therapy / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use; D011159:Population Surveillance / Q000379:methods; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013624:Taiwan
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: Chinese; antidiabetic drug; dipeptidyl peptidase-4 inhibitors; type 2 diabetes; 糖尿病用药,中国人,二肽基肽酶-4抑制剂,2型糖尿病