Time trends and geographical variation in prescribing of drugs for diabetes in England from 1998 to 2017.
Time trends and geographical variation in prescribing of drugs for diabetes in England from 1998 to 2017.
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DOI：
10.1111/dom.13346
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Goldacre B
中科院分区：
文献类型：
--
作者：
Curtis HJ;Dennis JM;Shields BM;Walker AJ;Bacon S;Hattersley AT;Jones AG;Goldacre B
测量二线非胰岛素糖尿病药物处方的变化。我们使用英国公开的处方数据集评估了1998年至2016年期间的时间趋势，并根据使用临床实践研究数据链向患者开具处方的顺序对其进行分层。我们计算了每类糖尿病药物占每年总药物的百分比。我们使用最近12个月（至2017年8月）的全科实践水平数据评估了处方的地理差异，并汇总到临床调试组。我们计算了距离，绘制了地图。二甲双胍治疗后的处方正在迅速变化。二肽基肽酶-4（DPP-4）抑制剂的使用显著增加，DPP-4抑制剂现在是最常见的二线药物（2016年占处方的43%）。钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂的使用也迅速增加（2016年14%的新二线处方，27%的新三线处方）。在治疗选择和每位患者的平均花费方面存在广泛的地理差异。相反，二甲双胍始终按照指南用作一线治疗。在英国，二甲双胍后糖尿病药物处方存在广泛的地理差异，与低成本磺脲类药物相比，更高成本的DPP-4抑制剂和SGLT-2抑制剂的使用越来越多。我们的研究结果强烈支持目前糖尿病药物的比较有效性试验的情况。
To measure the variation in prescribing of second‐line non‐insulin diabetes drugs. We evaluated time trends for the period 1998 to 2016, using England's publicly available prescribing datasets, and stratified these by the order in which they were prescribed to patients using the Clinical Practice Research Datalink. We calculated the proportion of each class of diabetes drug as a percentage of the total per year. We evaluated geographical variation in prescribing using general practice‐level data for the latest 12 months (to August 2017), with aggregation to Clinical Commissioning Groups. We calculated percentiles and ranges, and plotted maps. Prescribing of therapy after metformin is changing rapidly. Dipeptidyl peptidase‐4 (DPP‐4) inhibitor use has increased markedly, with DPP‐4 inhibitors now the most common second‐line drug (43% prescriptions in 2016). The use of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors also increased rapidly (14% new second‐line, 27% new third‐line prescriptions in 2016). There was wide geographical variation in choice of therapies and average spend per patient. In contrast, metformin was consistently used as a first‐line treatment in accordance with guidelines. In England there is extensive geographical variation in the prescribing of diabetes drugs after metformin, and increasing use of higher‐cost DPP‐4 inhibitors and SGLT‐2 inhibitors compared with low‐cost sulphonylureas. Our findings strongly support the case for comparative effectiveness trials of current diabetes drugs.
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影响因子：
16.2
作者：
Nathan DM;Buse JB;Kahn SE;Krause-Steinrauf H;Larkin ME;Staten M;Wexler D;Lachin JM;GRADE Study Research Group
通讯作者：
GRADE Study Research Group
影响因子：
3.6
作者：
Ruscitto, A.;Smith, B. H.;Guthrie, B.
通讯作者：
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影响因子：
5.1
作者：
Seidu, Samuel;Davies, Melanie J.;Khunti, Kamlesh
通讯作者：
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影响因子：
2.9
作者：
Sharma, Manuj;Nazareth, Irwin;Petersent, Irene
通讯作者：
Petersent, Irene
影响因子：
3.4
作者：
Bateman, DN;Good, AM;Kelly, CA
通讯作者：
Kelly, CA