Trends in Oral Antidiabetic Medication Initiation and Use in a HMO Population

The ADA (American Diabetic Association) and NICE (National Institute for Clinical Evidence) in the United Kingdom have established evidence based guidelines for the initiation and maintenance of oral antidiabetic and insulin therapy in patients with type 2 diabetes. We hypothesis that not all patients with type 2 diabetes at the University of Kentucky Health Maintenance Organization (UK-HMO) are initiated on oral antidiabetic medication according to guidelines and that many combinations of medication are used. To describe trends and combinations of prescription antidiabetic drugs and insulin usage among patients with type 2 diabetic at the UK-HMO. A retrospective medication utilization evaluation of prescription records at the UK-HMO identified all patients with an oral antidiabetic medicine or insulin in the file for the study period 7/1/2000 to 12/31/2005. A six-month screening period at the beginning of the data collection was used to assure only incident cases of type 2 diabetes were analyzed. Records were sorted by date medication was prescribed and aggregated into various medication combinations used by patients over time. Temporal changes in medication therapy were observed and results were compared with ADA and NICE guidelines. Patients were initially prescribed many different combinations of oral antidiabetic therapy and including monotherapy, double combination, triple combination, and insulin-only therapy. Over time, many different combinations of medication were used to control type 2 diabetes; however some patients did not have any change in initial regimen over the study period. Initial medications for type 2 diabetes in this study are not similar to those recommended by several worldwide guidelines, including the ADA and NICE. Combination therapy may be required for appropriate management of type 2 diabetes; however evidence base guidelines have been established for best clinical results. Further research into the rationale for many different combinations, especially on initiation, and the rationale for their use is being developed