Prescription of Insulin Glargine in Primary Care Practices in Germany

Abstract

Background: New classes of antidiabetic medications have been introduced, but details of their use are not well known. The aim was to assess prescription patterns and dosing for insulin glargine (market launch: 6/2000) in primary care patients.

Methods: Computerized data on prescriptions (Disease Analyzer, 6/1999 to 8/2003) from 277 general and internal medicine practices throughout Germany were analysed (67,402 diabetic patients; 340 incident glargine (age: 67±12 years) and 378 incident NPH users (66±11 years).

Results: Diabetes prevalence in the practices increased over the three-year period (5.1% to 6.2%). The highest increase was observed for insulin treated patients (+29%), followed by diet (+21%) and oral antidiabetics (+19%). Premixed insulin (short-acting insulin and NPH) remained constant as largest insulin group. A continuous increase of short-acting insulin analogues was found (+70%). Long-acting insulin analogues (glargine) increased threefold. Glargine was more often prescribed in combination with oral antidiabetics than NPH (76% vs 49%; p<0.05). Only about a quarter received short-acting insulin (NPH: 61%; p<0.05). The cumulative annual dose was higher among NPH users (geometric mean; NPH: 7971 IU; glargine: 5719 IU) (p<0.01), which persisted after adjusting for age, sex, and morbidity (p<0.01).

Conclusions: Diabetes prevalence continuously increased in German primary care practices from 1999 to 2003. The largest increase was found for insulin treatment, in particular, for short and long-acting insulin analogues. Insulin glargine was more often prescribed in combination with oral agents, whereas NPH insulin was more frequently prescribed with short-acting insulin, indicating different prescription patterns in primary care.

Key words

insulin therapy - general practice - glargine - pharmacoepidemiology

References

• 1 Bachmann W, Löbe A, Lacher F. Medikamentös bedingte Hypoglykämien bei Typ-II-Diabetes.  Diab Stoffw. 1995;  4 83-89
• 2 Barnett AH. A review of basal insulins.  Diabetic Medicine. 2003;  20 873-885
• 3 Cohen FJ, Neslusan CA, Conklin JE, Song X. Recent antihyperglycemic prescribing trends for U.S. privately insured patients with type 2 diabetes.  Diabetes Care. 2003;  26 1847-1851
• 4 Dietlein G, Schröder-Bernhardi D. Use of mediplus patient database in healthcare research.  Int J Pharmacol Therap. 2002;  40 130-133
• 5 Dunn CJ, Plosker GL, Keating GM, McKeage K, Scott LJ. Insulin glargine. An updated review of its use in the management of diabetes mellitus.  Drugs. 2003;  63 1743-1778
• 6 Grant RW, Pirraglia PA, Meigs JB, Singer DE. Trends in the complexity of diabetes care in the United States from 1991 to 2000.  Arch Intern Med. 2004;  164 1134-1139
• 7 Hauner H, Köster I, von Ferber L. Prävalenz des Diabetes mellitus in Deutschland 1998-2001. Sekundärdatenanalyse einer Versichertenstichprobe der AOK Hessen/KV Hessen.  Dtsch Med Wochenschr. 2003;  128 2632-2638
• 8 Hauner H. Insulin glargin - das erste lang wirkende Insulinanalogon. Ergebnisse einer Anwendungsbeobachtung mit 10258 Patienten.  Deutsches Ärzteblatt. 2003;  46 A3022-A3027
• 9 Janka HU, Plewe G, Riddle MC, Kliebe-Frisch C, Schweitzer MA, Yki-Järvinen H. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes.  Diabetes Care. 2005;  28 254-259
• 10 Joost HG, Mengel K. Antidiabetika. In: Schwabe U, Paffrath D (Eds.). Arzneiverordnungs-Report 2002. Springer, Berlin 2003 pp 170-185
• 11 Krobot KJ, Miller WC, Kaufman JS, Christensen DB, Preisser JS, Ibrahim MA. Quantifying delay in access to new medical treatment. An application of risk advancement period methodology.  Epidemiology. 2004;  15 202-207
• 12 Larme AC, Pugh JA. Attitudes of primary care providers toward diabetes. Barriers to guideline implementation.  Diabetes Care. 1998;  21 1391-1396
• 13 Meisinger C, Heier M, Doering A, Thorand B, Loewel H. KORA Group . Prevalence of known diabetes and antidiabetic therapy between 1984/1985 and 1999/2001 in southern Germany.  Diabetes Care. 2004;  27 2985-2987
• 14 Rathmann W. Data safety and drug safety in Germany: a closing gap?.  Pharmacoepidemiology Drug Safety. 2001;  10 625-630
• 15 Rosenstock J, Schwartz SL, Clark CM, Park GD, Donley DW, Edwards MB. Basal insulin therapy in type 2 diabetes. 28-week comparison of insulin glargine (HOE 901) and NPH insulin.  Diabetes Care. 2001;  24 631-636
• 16 UK Prospective Diabetes Study (UKPDS) Group: . Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 35).  Lancet. 1998;  352 837-853
• 17 Wysowski DK, Armstrong G, Governale L. Rapid increase in the use of oral antidiabetic drugs in the United States, 1990-2001.  Diabetes Care. 2003;  26 1852-1855

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