Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study
Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study
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DOI：
10.1136/bmjopen-2018-025806
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Shimasaki, Yukio
中科院分区：
文献类型：
--
作者：
Nishimura, Rimei;Kato, Haruka;Shimasaki, Yukio
目的了解日本2型糖尿病（T2DM）患者抗糖尿病药物使用、持久性和依从性的现实趋势。设计利用日本医疗数据中心（JMDC）和医疗数据视觉（MDV）数据库对2011-2015年行政索赔数据进行回顾性评估。日本2型糖尿病患者行政索赔数据库的设置分析。受试者为成人（年龄bb0 = 18岁），具有《国际疾病分类》第10版T2DM编码，并至少有一种降糖药处方。接受降糖治疗的未治疗（UT）或既往治疗（PT）患者的治疗模式；持续治疗12个月；12个月时坚持治疗。结果分别从JMDC和MDV数据库中纳入40908例和90421例患者。在指标（首次处方）日期，UT患者最常使用的治疗方法是二肽基肽酶-4抑制剂（DPP-4i） （JMDC: 44.0%, MDV: 54.8%）和PT患者联合治疗（74.6%,81.1%）。最常见的组合是DPP-4i +双胍（BG; 11.4%, 10.9%）、磺酰脲（SU; 8.4%, 11.0%）或BG+ SU（7.8%, 9.1%）。在任何一个数据库中，索引处方为DPP-4i以外的任何抗糖尿病药物类别的UT或PT患者中，最常见的添加或切换是DPP-4i。DPP-4i和BG组12个月的持续性指数单药治疗最高。除了胰岛素和胰高血糖素样肽-1激动剂，以及五种最常见的两药和三药联合治疗外，所有单药治疗方案的依从性都很高（>= 80%）。老年UT患者和接受= 3指数降糖药的患者持续时间更长。结论DPP-4i是日本T2DM患者最常用的降糖药物类别，且该药的持久性和依从性较高。
Objective To determine real-world trends in antidiabetic drug use, and persistence and adherence, in Japanese patients with type 2 diabetes mellitus (T2DM).Design Retrospective evaluation of administrative claims data (2011-2015) using the Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases.Setting Analysis of two administrative claims databases for Japanese patients with T2DM.Participants Adults (aged >= 18 years) with an International Classification of Diseases, 10th Revision code of T2DM and at least one antidiabetic drug prescription.Main outcome measures Treatment patterns in untreated (UT) or previously treated (PT) patients receiving antidiabetic therapy; persistence with treatment at 12 months; adherence to treatment at 12 months.Results 40 908 and 90 421 patients were included from the JMDC and MDV databases, respectively. The most frequently prescribed therapy at the index (first prescription) date was dipeptidyl peptidase-4 inhibitor (DPP-4i) in UT patients (JMDC: 44.0%, MDV: 54.8%) and combination therapy in PT patients (74.6%, 81.1%). Most common combinations were DPP-4i plus: biguanide (BG; 11.4%, 10.9%), sulfonylurea (SU; 8.4%, 11.0%) or BG+ SU (7.8%, 9.1%). In UT or PT patients from either database whose index prescription was for any antidiabetic drug class(es) other than DPP-4i, the most frequent add-on or switch was to DPP-4i. 12-month persistence with index monotherapy was highest with DPP-4i and BG. Adherence was high (>= 80%) for all monotherapy schedules, except insulin and glucagon-like peptide-1 agonist, and for the five most frequent two-drug and three-drug combinations. Persistence was greater in elderly UT patients and in those receiving = 3 index antidiabetic drug classes.Conclusions The findings indicate that DPP-4i is the most commonly used antidiabetic drug class in Japanese patients with T2DM, and persistence and adherence to this antidiabetic drug class are high.