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. 2017 Mar;8(2):227-234.
doi: 10.1111/jdi.12567. Epub 2016 Sep 15.

Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database

Makito Tanabe  1 , Ryoko Motonaga  1 , Yuichi Terawaki  1 , Takashi Nomiyama  1 , Toshihiko Yanase  1
Affiliations

Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database

Makito Tanabe et al. J Diabetes Investig. 2017 Mar.

Abstract

Aims/introduction: In treatment algorithms of type 2 diabetes mellitus in Western countries, biguanides are recommended as first-line agents. In Japan, various oral hypoglycemic agents (OHAs) are available, but prescription patterns are unclear.

Materials and methods: Data of 7,108 and 2,655 type 2 diabetes mellitus patients in study 1 and study 2, respectively, were extracted from the Medical Data Vision database (2008-2013). Cardiovascular disease history was not considered in study 1, but was in study 2. Initial choice of OHA, adherence to its use, effect on glycated hemoglobin levels for 2 years and the second choice of OHA were investigated.

Results: In study 1, α-glucosidase inhibitor, glinide and thiazolidinedione were preferentially medicated in relatively lower glycated hemoglobin cases compared with other OHAs. The two most prevalent first prescriptions of OHAs were biguanides and dipeptidyl peptidase-4 inhibitors, and the greatest adherence was for α-glucosidase inhibitors. In patients treated continuously with a single OHA for 2 years, improvement in glycated hemoglobin levels was greatest for dipeptidyl peptidase-4 inhibitors. As a second OHA added to the first OHA during the first 2 years, dipeptidyl peptidase-4 inhibitors were chosen most often, especially if a biguanide was the first OHA. In study 2, _targeting patients with a cardiovascular disease history, a similar tendency to study 1 was observed in the first choice of OHA, adherence and the second choice of OHA.

Conclusions: Even in Japanese type 2 diabetes mellitus patients, a Western algorithm seems to be respected to some degree. The OHA choice does not seem to be affected by a cardiovascular disease history.

Keywords: Cardiovascular disease; Oral hypoglycemic agent; Type 2 diabetes mellitus.

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Figures

Figure 1
Figure 1
Changes in glycated hemoglobin (HbA1c) value (National Glycohemoglobin Standardization Program; mean ± standard error [SE]) between 0 weeks and 104 weeks for patients in whom a single oral hypoglycemic agent was continued for 2 years. ‘n’ denotes the number of patients (including patients without HbA1c data) at the week 104. The number of patients includes patients without HbA1c data at week 104. A total of 52 patients did not have HbA1c data at the final administration among 1,307 patients, so they were excluded from ancova. Estimates and P‐values by ancova, *P < 0.05.
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