title: Trend of antihyperglycaemic therapy and glycaemic control in 184,864 adults with type 1 or 2 diabetes between 2002 and 2014: Analysis of real-life data from the DPV registry from Germany and Austria.
abstract: OBJECTIVE
  To analyse time trends of antihyperglycaemic therapy and glycaemic control in adult subjects with type 1, or type 2 diabetes between 2002 and 2014 in Germany/Austria.
  
  
  METHODS
  184,864 adults with diabetes (35,144 type 1 diabetes (T1D), 149,720 type 2 diabetes (T2D)) from the DPV-database documented between 2002 and 2014 were included. Regression models were applied for antihyperglycaemic therapy in T2D (non-pharmacological, OADs only, insulin±OADs), insulin therapy in T1D (CT, ICT, CSII) and T2D (BOT, SIT, CT, ICT, CSII), for the use of insulin analogues, and for glycaemic control (HbA1C, severe hypoglycaemia), adjusting for confounders sex, age, and diabetes duration.
  
  
  RESULTS
  In T1D, CT (2002:19.7%; 2014:16.0%) and ICT (2002:66.8%; 2014:52.4%) decreased, while CSII increased from 13.5% to 31.5%. In T2D, non-pharmacological treatment became less frequent (2002:36.0%, 2014:21.8%), the use of OADs (2002:19.3%, 2014:28.9%) and insulin±OADs (2002:44.6%, 2014:49.4%) increased. BOT increased from 7.9% to 18.9%, SIT decreased from 12.0% to 8.3%. ICT slightly increased (2002:44.0%, 2014:45.3%), CT decreased (2002:35.8%, 2014:27.2%). Insulin analogues were used more frequently in T1D (rapid-acting:2002:46.8%, 2014:84.8%; long-acting:2002:26.0%, 2014:54.8%) and in T2D (rapid-acting:2002:26.0%, 2014:43.5%; long-acting:2002:13.7%, 2014:53.6%). Until 2011, HbA1C increased in T1D and T2D, but then decreased again. High variability in the rate of hypoglycaemia was observed.
  
  
  CONCLUSIONS
  This observational study indicates an increased use of insulin pumps in T1D. In T2D, non-pharmacological therapy decreased, and insulin therapy, particular as BOT, rose. An increase in the use of rapid- and long-acting insulin analogues was present in both patient-groups. Time trend was less clear in glycaemic control.
authors.affiliation: University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany. Electronic address: barbara.bohn@uni-ulm.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bohn
authors.affiliation: Centre of Diabetes and Metabolic Disorders, Karlsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kerner
authors.affiliation: University Hospital of Freiburg, Division of Endocrinology & Diabetology, Department of Medicine II, Freiburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Seufert
authors.affiliation: Centre for Diabetes and Nutrition Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kempe
authors.affiliation: Academic Hospital Paul Gerhardt Stift, Lutherstadt Wittenberg, Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Germany.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jehle
authors.affiliation: Diabetes-Practice Dr. Best, Essen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Best
authors.affiliation: Diabetes Practice, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Füchtenbusch
authors.affiliation: University Hospital of Rostock, Clinic for Internal Medicine, Department of Endocrinology and Metabolic Diseases, Rostock, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Knauerhase
authors.affiliation: University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Department of Internal Medicine I, St. Poelten, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hofer
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.affiliation: University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000328:Adult; D001317:Austria; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012042:Registries; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting
keywords: Adults; Antihyperglycaemic therapy; Glycaemic control; Time trend; Type 1 diabetes; Type 2 diabetes