| アブストラクト | AIMS: To identify patient-specific factors associated with early metformin treatment modification among type 2 diabetes patients before and after implementation of the updated 2015 NICE (National Institute for Health and Care Excellence) guideline. METHODS: We conducted a population-based cohort study using data from the Clinical Practice Research Datalink GOLD database (2009-2016). Patients >/= 18 years, newly treated with metformin only, during the period of valid data collection were included. The first prescription defined start of follow-up. Determinants of treatment modification in two cohorts (before and after implementation of the updated guideline) were studied by time-dependent Cox proportional hazards regression. RESULTS: After implementation of the updated guideline, patients were less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% vs 2.2%) and more likely to receive dipeptidyl peptidase-4 inhibitors (15.8% vs 27.1%) or sodium-glucose cotransporter-2 inhibitors (0.8% vs 9.9%). Some determinants influenced general practitioners' prescribing differently after implementation of the updated guideline compared to before, including a high body mass index and heart failure. CONCLUSIONS: Our results indicate that a first step towards tailored prescribing has been made. However, not all determinants that are important to consider when prescribing second-line glucose-lowering agents were of influence on general practitioners' prescribing. |
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| 投稿者 | van Dalem, Judith; Brouwers, Martijn C G J; Burden, Andrea M; Stehouwer, Coen D A; Klungel, Olaf H; de Vries, Frank; Driessen, Johanna H M |
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| 組織名 | Department of Clinical Pharmacy, Maastricht University Medical Centre+,;Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht,;Maastricht University Medical Centre+, Maastricht, the Netherlands.;Department of Internal Medicine, Division of Endocrinology and Metabolic Disease,;Cardiovascular Research Institute Maastricht (CARIM), Maastricht University;Medical Centre+, Maastricht, the Netherlands.;Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical;Sciences, ETH Zurich, Switzerland.;Department of Internal Medicine and Cardiovascular Research Institute Maastricht;(CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Utrecht, the Netherlands.;Maastricht University Medical Centre+, Maastricht, the Netherlands; Division of;Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Utrecht, the Netherlands. Electronic address:;f.devries@uu.nl.;Pharmaceutical Sciences, Utrecht, the Netherlands; NUTRIM School for Nutrition;and Translational Research in Metabolism, Maastricht University, Maastricht, the;Netherlands. |
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