Prescribing pattern and predictors associated with the use of hypoglycaemic drugs: A cross-sectional study in Italian general practice

OBJECTIVE: To describe first and second-line use of antidiabetic drugs for management of type 2 diabetes in Italy, and to identify potential predictors associated with the use of antihyperglycemic drugs. METHODS: Primary care data were obtained from 400 Italian General Practitioners (GPs) providing information to the Health Search/Thales Database (HSD). All patients with a doctor-diagnosis of type 2 diabetes during the years 1996–2006 were selected. First and second-line drug therapy episodes were evaluated by assessing the sequential fulfilment of prescriptions of a particular antihyperglycemic drug class (or combination), which followed the diabetes diagnosis. A sub-sample of diabetic patients, with a registered diagnosis until the December 31, 2003 was also selected to evaluate the time-dependant clinical and demographic characteristics associated with the use of different antihyperglycemic drugs across the years 2004–2006. RESULTS: A total of 19,561 diabetic patients had diabetes drug therapy episodes between 1996 and 2006. Monotherapy with metformin increased (from 4.1% in 1996 to 44.8% in 2006), while monotherapy with sulfonylureas decreased over time (from 32.7% to 23.9%) as first line therapy. Thiazolidinedione (from 0.3% to 0.6%)and other oral antihyperglycemics (from 0.7% to 4.3%) also raised over the period. Second-line drug therapy episodes shown the same trend during study period with a substantial increased use of thiazolidinedione (from 2.5% to 3.8%). As regards prevalent patients characteristics, hypercholesteremia and obesity were significantly associated with the use of thiazolidinediones while coronary artery disease, chronic renal and hepatic failure were associated with insulin use. CONCLUSION: Antihyperglycemic prescription patterns in Italy dramatically changed from 1996 to 2006 with increased use of metformin and decreased use of sulfonylureas. The introduction of thiazolidinediones to the marketplace seems not change the management of diabetes mellitus as first line-treatment, although this drug class is preferred in chronic patients particularly affected by hypercholesteremia and obesity.