Prescription trends and the selection of initial oral antidiabetic agents for patients with newly diagnosed type 2 diabetes: a nationwide study

C. H. Liu, S. T. Chen, C. H. Chang, L. M. Chuang, M. S. Lai

Research output: Contribution to journalArticle

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Abstract

Objectives The aim of this study was to examine the characteristics of patients, physicians, and medical facilities, and their association with prescriptions that do not include metformin as the initial oral antidiabetic agent. Study design Observational, cross-sectional study. Methods Patients with incident type 2 diabetes between January 1, 2006, and December 31, 2010, were identified from the Taiwan National Insurance Research Database. We describe trends in the initial prescription of antidiabetic medications that do not contain metformin during the study period. A multivariable logistic model and a multilevel linear model were used in the analysis of factors at a range of levels (patient, physician, and medical facility), which may be associated with the selection of oral antidiabetic drugs. Results During the study period, the proportion of prescriptions that did not include metformin declined from 43.8% to 26.2%. Male patients were more likely to obtain non-metformin prescriptions (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.08–1.23), and the likelihood that a patient would be prescribed a non-metformin prescription increased with age. Physicians aged ≥35 years and those with specialties other than endocrinology tended to prescribe non-metformin prescriptions. Metformin was less commonly prescribed in for-profit hospitals (adjusted OR: 1.34, 95% CI: 1.11–1.61) and hospitals in smaller cities (adjusted OR: 1.28, 95% CI: 1.05–1.57) and rural areas (adjusted OR: 1.83, 95% CI: 1.32–2.54). Conclusions Disparities continue to exist in clinical practice with regard to the treatment of diabetes. These inequalities appear to be linked to a variety of factors related to patients, physicians, and medical facilities. Further study will be required to understand the effects of continuing medical education in enhancing adherence to clinical guidelines.

Original languageEnglish
Pages (from-to)20-27
Number of pages8
JournalPublic Health
Volume152
DOIs
Publication statusPublished - Nov 1 2017

Fingerprint

Hypoglycemic Agents
Type 2 Diabetes Mellitus
Prescriptions
Metformin
Odds Ratio
Confidence Intervals
Physicians
Continuing Medical Education
Endocrinology
Insurance
Taiwan
Statistical Factor Analysis
Observational Studies
Linear Models
Cross-Sectional Studies
Logistic Models
Databases
Guidelines
Research

Keywords

  • Antidiabetic drugs
  • Drug utilization
  • Metformin

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Prescription trends and the selection of initial oral antidiabetic agents for patients with newly diagnosed type 2 diabetes : a nationwide study. / Liu, C. H.; Chen, S. T.; Chang, C. H.; Chuang, L. M.; Lai, M. S.

In: Public Health, Vol. 152, 01.11.2017, p. 20-27.

Research output: Contribution to journalArticle

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abstract = "Objectives The aim of this study was to examine the characteristics of patients, physicians, and medical facilities, and their association with prescriptions that do not include metformin as the initial oral antidiabetic agent. Study design Observational, cross-sectional study. Methods Patients with incident type 2 diabetes between January 1, 2006, and December 31, 2010, were identified from the Taiwan National Insurance Research Database. We describe trends in the initial prescription of antidiabetic medications that do not contain metformin during the study period. A multivariable logistic model and a multilevel linear model were used in the analysis of factors at a range of levels (patient, physician, and medical facility), which may be associated with the selection of oral antidiabetic drugs. Results During the study period, the proportion of prescriptions that did not include metformin declined from 43.8{\%} to 26.2{\%}. Male patients were more likely to obtain non-metformin prescriptions (adjusted odds ratio [OR]: 1.15; 95{\%} confidence interval [CI]: 1.08–1.23), and the likelihood that a patient would be prescribed a non-metformin prescription increased with age. Physicians aged ≥35 years and those with specialties other than endocrinology tended to prescribe non-metformin prescriptions. Metformin was less commonly prescribed in for-profit hospitals (adjusted OR: 1.34, 95{\%} CI: 1.11–1.61) and hospitals in smaller cities (adjusted OR: 1.28, 95{\%} CI: 1.05–1.57) and rural areas (adjusted OR: 1.83, 95{\%} CI: 1.32–2.54). Conclusions Disparities continue to exist in clinical practice with regard to the treatment of diabetes. These inequalities appear to be linked to a variety of factors related to patients, physicians, and medical facilities. Further study will be required to understand the effects of continuing medical education in enhancing adherence to clinical guidelines.",
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N2 - Objectives The aim of this study was to examine the characteristics of patients, physicians, and medical facilities, and their association with prescriptions that do not include metformin as the initial oral antidiabetic agent. Study design Observational, cross-sectional study. Methods Patients with incident type 2 diabetes between January 1, 2006, and December 31, 2010, were identified from the Taiwan National Insurance Research Database. We describe trends in the initial prescription of antidiabetic medications that do not contain metformin during the study period. A multivariable logistic model and a multilevel linear model were used in the analysis of factors at a range of levels (patient, physician, and medical facility), which may be associated with the selection of oral antidiabetic drugs. Results During the study period, the proportion of prescriptions that did not include metformin declined from 43.8% to 26.2%. Male patients were more likely to obtain non-metformin prescriptions (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.08–1.23), and the likelihood that a patient would be prescribed a non-metformin prescription increased with age. Physicians aged ≥35 years and those with specialties other than endocrinology tended to prescribe non-metformin prescriptions. Metformin was less commonly prescribed in for-profit hospitals (adjusted OR: 1.34, 95% CI: 1.11–1.61) and hospitals in smaller cities (adjusted OR: 1.28, 95% CI: 1.05–1.57) and rural areas (adjusted OR: 1.83, 95% CI: 1.32–2.54). Conclusions Disparities continue to exist in clinical practice with regard to the treatment of diabetes. These inequalities appear to be linked to a variety of factors related to patients, physicians, and medical facilities. Further study will be required to understand the effects of continuing medical education in enhancing adherence to clinical guidelines.

AB - Objectives The aim of this study was to examine the characteristics of patients, physicians, and medical facilities, and their association with prescriptions that do not include metformin as the initial oral antidiabetic agent. Study design Observational, cross-sectional study. Methods Patients with incident type 2 diabetes between January 1, 2006, and December 31, 2010, were identified from the Taiwan National Insurance Research Database. We describe trends in the initial prescription of antidiabetic medications that do not contain metformin during the study period. A multivariable logistic model and a multilevel linear model were used in the analysis of factors at a range of levels (patient, physician, and medical facility), which may be associated with the selection of oral antidiabetic drugs. Results During the study period, the proportion of prescriptions that did not include metformin declined from 43.8% to 26.2%. Male patients were more likely to obtain non-metformin prescriptions (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.08–1.23), and the likelihood that a patient would be prescribed a non-metformin prescription increased with age. Physicians aged ≥35 years and those with specialties other than endocrinology tended to prescribe non-metformin prescriptions. Metformin was less commonly prescribed in for-profit hospitals (adjusted OR: 1.34, 95% CI: 1.11–1.61) and hospitals in smaller cities (adjusted OR: 1.28, 95% CI: 1.05–1.57) and rural areas (adjusted OR: 1.83, 95% CI: 1.32–2.54). Conclusions Disparities continue to exist in clinical practice with regard to the treatment of diabetes. These inequalities appear to be linked to a variety of factors related to patients, physicians, and medical facilities. Further study will be required to understand the effects of continuing medical education in enhancing adherence to clinical guidelines.

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