title: Prescribing differences in family practice for diabetic patients in Germany according to statutory or private health insurance: the case of DPP-4-inhibitors and GLP-1-agonists.
abstract: The objective of this study was to analyze prescription decisions for family practice (FP) patients with Diabetes mellitus type 2 (DM2) using the case of the incretin mimetics Dipeptidyl peptidase-4 (DDP-4) inhibitors and Glucagon-like peptide-1 (GLP-1) agonists dependent on patients' health insurance status (statutory or private) in Germany. This study is important since the scientific debate is still open with regard to DPP-4-inhibitors and GLP-1-agonists, where some critics are raising questions on potential long-term risks for patients.
  
  
  
  Data for this analysis were sourced from the German health services research register CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork), in which FP health services information, generated by family practitioners, is continuously collated, e.g. patients' health insurance status, morbidity and pharmacotherapy. Patients with Diabetes mellitus type 1 (DM1) were excluded from the study.
  
  
  
  From the family practices collaborating in the CONTENT research network, there were 7298 patients treated with pharmacotherapeutic agents for DM2 between 01.09.2009 and 31.08.2014. 586 (8.03 %) of these patients had private insurance. Prescriptions for the incretin mimetics were 40.6 % higher (9.7 vs. 6.9 %; p < 0.0001) for patients with private insurance compared to patients with statutory health insurance. This finding was confirmed with multivariable analyses.
  
  
  
  There was a statistically significant difference found in prescription patterns according to the patient's health insurance status for the incretin mimetics in this sample population of German patients with DM2. Obviously, these differences result from the eligibility for reimbursement according to patients' health insurance status. Whether incretin mimetics pose specific long term risks for particular patients is yet to be determined.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany. g.laux@med.uni-heidelberg.de.
authors.forename: Gunter
authors.initials: G
authors.lastname: Laux
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Berger
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: AQUA-Institute for Applied Quality Promotion and Research in Health Care, Göttingen, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Kaufmann-Kolle
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Leutgeb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D005858:Germany; D052216:Glucagon-Like Peptide 1 / Q000819:agonists*; D006801:Humans; D054795:Incretins; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D057786:Peptidomimetics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D054795:Incretins; D057786:Peptidomimetics; D052216:Glucagon-Like Peptide 1