[[alternative]]The distribution of prescribing patterns analysis of oral diabetes medications before refill prescription among patients with type II diabetes mellitus

[[abstract]]目的：探討領有連續處方箋的第二型糖尿病患，在取得第二型糖尿病初診斷後，前三個月(前3次領藥日)針對口服降血糖藥物的開藥型態。方法：本研究採全民健康保險研究資料庫2003年新增病例「糖尿病歸人檔」，擷取2003年間主、次診斷為第二型糖尿病患，且持有慢性病連續處方箋者為主要分析世代，觀察取得第二型糖尿病初診斷的前三個月，並以仿造決策樹想法呈現口服降血糖藥物之開藥型態，而口服降血糖藥物則是依據藥品藥理治療分類ATC碼進行分類，共七類，分別為雙胍類、磺胺類、複方、α葡萄糖苷酶抑制劑、噻唑烷二酮類、二肽基肽酶-4、其他糖尿病降血糖藥等。本研究依資料收集方式為次級資料分析；依資料收集時間為回溯性研究。結果：本研究以領有慢性病連續處方箋作為主要研究對象，共44,430人，平均3.18年內取得慢箋；取得糖尿病初診斷後，前三次就診紀錄大抵為三個月內的就診期間。慢箋前以雙胍類+磺胺類+複方+ α葡萄糖苷酶抑制劑+噻唑烷二酮類+ 其他為最多；前三次領藥日以雙胍類+磺胺類為最多(18.50%)；開立一種藥物中第一次領藥日以磺胺類（51.20%）為最多，兩種及三種藥物則第一次領藥日會以雙胍類+磺胺類（86.41%）為最多；三種藥物以上之開藥組合多為雙胍類+磺胺類+複方+ α葡萄糖苷酶抑制劑+噻唑烷二酮類+其他糖尿病降血糖藥；第一次開立磺胺類（51.20%），則第二次有28.40%機率會開立雙胍類 + 磺胺類；第一次領藥日為雙胍類（42.85%）或噻唑烷二酮類（5.62%）時，其第二、三次的開藥組合與第一次開立磺胺類者相同，除比例上差異外，第一次開立噻唑烷二酮類時，第二次開立一種藥物比例較高。結論：本研究發現前三次就診紀錄大抵為三個月內的就診期間；開立一種藥物時不外乎雙胍類及磺胺類，然而綜觀整體開藥型態則多為兩種藥物以上。因此首先就診方面應提倡規律看診；再者，第一次領藥日多為多重藥物，可見病患多為嚴重時才前往就醫，導致病情嚴重而需服用較多藥物，因此應該將用藥時機提前。最後，本研究結果能作為初診糖尿病病患的參考依據。[[abstract]]Objective: This purpose of this study was to investigate the prescribing patterns, especially for the oral anti-hyperglycemic medicines, in the first three months after the first time diagnosis among type II diabetes patients who has applied for the refill prescription. Methods: We conducted the National Health Insurance Research Database, which sampled 120000 newly diagnosed diabetes patients in 2003, and we selected the type II diabetes patients with all claims records from 2003. The study subjects were those who had applied for the refill prescription as the cohort and observed the prescribing patterns in the first three months. In this study, we imitated the decision tree structure to display the combinations of oral anti-hyperglycemic drugs. Those drugs were categorized into seven parts based on Anatomical Therapeutic Chemical (ATC). Seven parts mentioned above, namely Biguanides, Sulfonylurea, Compound, Alpha glucosidase inhibitors, Thiazolidinediones, dipeptidyl peptidase 4 inhibitors and others oral anti-hypoglycemic drugs. It was the secondary data analysis with the retrospective study design. Results: In this study, there were remained 44,430 cases after selection criteria. The average years to get the refill prescription were 3.18 years. After the first time diagnosis to the first three month, the majority was Biguanides+ Sulfonylurea + Compound+Alpha glucosidase inhibitors +Thiazolidinediones +others(17.97%). In the first three prescribing times, the majority was Biguanides + Sulfonylurea (18.50%) in this first visit. In addition, in the two or three drug combinations in the first visit, the majority was Biguanides + Sulfonylurea (86.41%). In the most drug combinations over three drugs items were Biguanides+ Sulfonylurea + Compound + Alpha glucosidase inhibitors + Thiazolidinediones +others (30.52%). When checking prescribing patterns in the first three time, the majority was sulfonylurea (51.20%) in the first visit, followed by the Biguanides + Sulfonylurea (28.4%) in the second visit. When the second and third majority were Biguanides (42.85%) or Thiazolidinediones (5.62%) in the first visit, the prescribing patterns in the second and third visit were the same as the majority in sulfonylurea, despite in the difference of proportions. Further, when the Thiazolidinediones was prescribed in the first time, providers delivered the only one drug in the most situations in the second times.Conclusion: This study found that the first three visits might cover the first three month in the study period. The majority for the only one medicine is either BGs or SUs. However, the most prescribing patterns are over two drugs in combinations from the study observation, which is not consistent with the guideline from American Diabetes Association (ADA). In addition, we found providers prescribed multiple drugs in the first time visit which imply that patients may not be awareness their diabetes status or lack of proper knowledge in diabetes self-care. Health authorities should encourage patients to check providers regularly in the first three months and conceive useful strategies for health education to provide the patients best interest. Finally, the results of this study can be used as a reference for newly diagnosed diabetes mellitus patients