title: A retrospective cohort analysis of hypoglycaemic and cardiovascular agent use in young adults in the Irish primary care setting.
abstract: OBJECTIVE
  The prevalence of type 2 diabetes in young adults is increasing, yet little is known about medication use in this population. This study aimed to describe hypoglycaemic and cardiovascular treatment patterns in young adults newly treated with oral hypoglycaemic agents.
  
  
  METHODS
  A retrospective cohort study from 2008-2011 was conducted using the Irish national pharmacy claims database. Subjects aged 15-39 years were analysed for use of hypoglycaemic therapy, subsequent regimen changes, and any co-prescription of cardiovascular agents 1 year after treatment initiation. Cox-proportional-hazards regression and logistic regression were used to examine factors associated with non-persistence to initial hypoglycaemic therapy (in males only), insulin use as a regimen change, and use of cardiovascular agents. Hazard ratios (HR), odds ratios (OR), and 95 % confidence intervals (CI) are presented.
  
  
  RESULTS
  There were 5284 individuals initiated on hypoglycaemic agents. Most were initiated on metformin (88 %); 13 % of subjects received a hypoglycaemic agent regimen change, with insulin being used in 26 % of these cases. A total of 38 % of males were non-persistent with their initial hypoglycaemic agent, with males aged 15-29 years and those on sulphonylureas significantly more likely to be non-persistent with therapy. Over 40 % of subjects were initiated on cardiovascular agents. Females were less likely to receive cardiovascular agents [OR 0.50 (95 % CI 0.42-0.83)].
  
  
  CONCLUSIONS
  Treatment patterns were found to be associated with high levels of non-persistence, substantial use of insulin, and a low use of cardiovascular agents. This may pose problems for the management of the long-term complications associated with type 2 diabetes.
authors.affiliation: School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland. grimesrt@tcd.ie.
authors.forename: R T
authors.initials: RT
authors.lastname: Grimes
authors.affiliation: Population Health Division, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Paediatrics, Trinity College Dublin, Dublin, Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Hoey
authors.affiliation: National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Tilson
authors.affiliation: School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
authors.forename: M C
authors.initials: MC
authors.lastname: Henman
mesh_terms: D000293:Adolescent; D000328:Adult; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D016017:Odds Ratio; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: Cardiovascular complications; Hypoglycaemic agents; Real world treatment patterns; Type 2 diabetes mellitus; Young adults