PMID- 29108837 OWN - NLM STAT- MEDLINE DCOM- 20180515 LR - 20221207 IS - 1879-114X (Electronic) IS - 0149-2918 (Linking) VI - 39 IP - 11 DP - 2017 Nov TI - Factors Associated with Type 2 Diabetes Mellitus Treatment Choice Across Four European Countries. PG - 2296-2310.e14 LID - S0149-2918(17)31003-2 [pii] LID - 10.1016/j.clinthera.2017.09.016 [doi] AB - PURPOSE: The aim of this analysis was to identify factors associated with the choice of type 2 diabetes mellitus (T2DM) therapy at the time of intensification of antidiabetic treatment across 4 European countries. METHODS: Antidiabetic drug prescription/dispensing records and patients' characteristics were obtained from the electronic health care records of patients with T2DM from the Netherlands (NL), Italy, and Spain (ES) (all, 2007-2011); and the United Kingdom (UK; 2008-2012). Oral monotherapy was defined as first-line; oral dual therapy, as second-line; >2 oral treatments or oral combined with an injectable, as third-line; and injectables only, as fourth-line treatment. Treatment intensification was defined as the start of a higher line of treatment. Comedication, comorbidities, clinical parameters, and other factors associated with treatment choice were identified using multivariate relative risk estimation by Poisson regression with robust error variance. FINDINGS: In the 5-year study period, 485,120 patients (79% of the treated T2DM population) underwent treatment intensification. Changes in treatment choice were clearly visible over the study period, such as a decline in the use of thiazolidinediones (NL, ES, UK) and increases in the use of dipeptidyl peptidase-4 inhibitors (DPP4i) (NL, ES, UK) and glucagon-like peptide-1 receptor agonists (UK). With first-line treatment, advanced age and renal comorbidity were associated with the use of sulfonylureas (SUs; all countries), whereas high body mass index (BMI) was inversely associated with SU use in the United Kingdom and Spain. With second-line treatment, advanced age was associated with metformin + SU use (all countries); and renal comorbidity with SU + DPP4i use in the United Kingdom and the Netherlands. High BMI was associated with metformin + thiazolidinedione (TZD) use in the United Kingdom and Spain, and with metformin + DPP4i in the United Kingdom. With third-line treatment, advanced age and renal comorbidity were associated with the use of SU + insulin (NL, ES, UK). Hemoglobin A(1c) >8.5% was positively associated, and high BMI was inversely associated, with the use of any third-line combination containing insulin. Across treatment lines TZD and metformin were negatively associated with renal and cardiac morbidity. Second and third line treatment choices strongly depended on prior treatments. With fourth-line treatment, women were more likely to receive glucagon-like peptide-1 receptor agonists than were men in the United Kingdom and Spain. IMPLICATIONS: The results suggest that the main factors driving treatment choice at any stage of intensification were age, hemoglobin A(1c), BMI, renal and cardiac morbidity, and treatment history. These drivers were consistent with guidelines on, and contraindications of, specific medications. Differences between countries were generally consistent with, but not solely attributable to, differences in local guidelines and reimbursement policies. CI - Copyright (c) 2017 Elsevier HS Journals, Inc. All rights reserved. FAU - Heintjes, Edith M AU - Heintjes EM AD - PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands. Electronic address: edith.heintjes@pharmo.nl. FAU - Overbeek, Jetty A AU - Overbeek JA AD - PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands. FAU - Hall, Gillian C AU - Hall GC AD - Grimsdyke House, London, United Kingdom. FAU - Prieto-Alhambra, Daniel AU - Prieto-Alhambra D AD - Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and Centro de Investigacion Biomedica en Red de Fragilidad y Envejecimiento Saludable (CIBERFes), Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom. FAU - Lapi, Francesco AU - Lapi F AD - Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy. FAU - Hammar, Niklas AU - Hammar N AD - AstraZeneca R&D, Molndal, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. FAU - Bezemer, Irene D AU - Bezemer ID AD - PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20171104 PL - United States TA - Clin Ther JT - Clinical therapeutics JID - 7706726 RN - 0 (Dipeptidyl-Peptidase IV Inhibitors) RN - 0 (Glucagon-Like Peptide-1 Receptor) RN - 0 (Glycated Hemoglobin A) RN - 0 (Hypoglycemic Agents) RN - 0 (Insulin) RN - 0 (Sulfonylurea Compounds) RN - 0 (Thiazolidinediones) RN - 9100L32L2N (Metformin) RN - AA68LXK93C (2,4-thiazolidinedione) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Body Mass Index MH - Diabetes Mellitus, Type 2/*drug therapy MH - Dipeptidyl-Peptidase IV Inhibitors/therapeutic use MH - Drug Therapy, Combination MH - Europe MH - Female MH - Glucagon-Like Peptide-1 Receptor/agonists MH - Glycated Hemoglobin/analysis MH - Humans MH - Hypoglycemic Agents/*therapeutic use MH - Insulin/therapeutic use MH - Male MH - Metformin/therapeutic use MH - Middle Aged MH - Sulfonylurea Compounds/therapeutic use MH - Thiazolidinediones/therapeutic use MH - Young Adult OTO - NOTNLM OT - Europe OT - glucose-lowering drugs OT - guidelines OT - treatment choice OT - type 2 diabetes mellitus EDAT- 2017/11/08 06:00 MHDA- 2018/05/16 06:00 CRDT- 2017/11/08 06:00 PHST- 2017/07/20 00:00 [received] PHST- 2017/09/29 00:00 [accepted] PHST- 2017/11/08 06:00 [pubmed] PHST- 2018/05/16 06:00 [medline] PHST- 2017/11/08 06:00 [entrez] AID - S0149-2918(17)31003-2 [pii] AID - 10.1016/j.clinthera.2017.09.016 [doi] PST - ppublish SO - Clin Ther. 2017 Nov;39(11):2296-2310.e14. doi: 10.1016/j.clinthera.2017.09.016. Epub 2017 Nov 4.