Type 2 Diabetes Mellitus Treatment Patterns Across Europe: A Population-based Multi-database Study.
OBJECTIVE
The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines.


METHODS
Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns.


RESULTS
A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by "other treatment," mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment.


CONCLUSIONS
This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries.
PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands. Electronic address: jetty.overbeek@pharmo.nl.
Jetty A
JA
Overbeek
PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
Edith M
EM
Heintjes
GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom.
Daniel
D
Prieto-Alhambra
Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France.
Patrick
P
Blin
Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France.
Régis
R
Lassalle
Grimsdyke House, London, United Kingdom.
Gillian C
GC
Hall
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Francesco
F
Lapi
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Elisa
E
Bianchini
AstraZeneca R&D, Mölndal, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Niklas
N
Hammar
PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
Irene D
ID
Bezemer
PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
Ron M C
RMC
Herings
D000368:Aged; D002219:Carbamates / Q000627:therapeutic use; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054795:Incretins / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use; D013453:Sulfonylurea Compounds / Q000627:therapeutic use
D002219:Carbamates; D007004:Hypoglycemic Agents; D054795:Incretins; D010880:Piperidines; D013453:Sulfonylurea Compounds; C072379:repaglinide; D008687:Metformin
Europe; diabetes mellitus, type 2; guidelines; hypoglycemic agents; treatment pattern