Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study

Abstract

Objective: To investigate trends in incident and prevalent diagnoses of type 2 diabetes mellitus (T2DM) and its pharmacological treatment between 2000 and 2013.

Design: Analysis of longitudinal electronic health records in The Health Improvement Network (THIN) primary care database.

Setting: UK primary care.

Participants: In total, we examined 8,838,031 individuals aged 0-99 years.

Outcome measures: The incidence and prevalence of T2DM between 2000 and 2013, and the effect of age, sex and social deprivation on these measures were examined. Changes in prescribing patterns of antidiabetic therapy between 2000 and 2013 were also investigated.

Results: Overall, 406,344 individuals had a diagnosis of T2DM, of which 203,639 were newly diagnosed between 2000 and 2013. The incidence of T2DM rose from 3.69 per 1000 person-years at risk (PYAR) (95% CI 3.58 to 3.81) in 2000 to 3.99 per 1000 PYAR (95% CI 3.90 to 4.08) in 2013 among men; and from 3.06 per 1000 PYAR (95% CI 2.95 to 3.17) to 3.73 per 1000 PYAR (95% CI 3.65 to 3.82) among women. Prevalence of T2DM more than doubled from 2.39% (95% CI 2.37 to 2.41) in 2000 to 5.32% (95% CI 5.30 to 5.34) in 2013. Being male, older, and from a more socially deprived area was strongly associated with having T2DM, (p<0.001). Prescribing changes over time reflected emerging clinical guidance and novel treatments. In 2013, metformin prescribing peaked at 83.6% (95% CI 83.4% to 83.8%), while sulfonylureas prescribing reached a low of 41.4% (95% CI 41.1% to 41.7%). Both remained, however, the most commonly used pharmacological treatments as first-line agents and add-on therapy. Thiazolidinediones and incretin based therapies (gliptins and GLP-1 analogues) were also prescribed as alternate add-on therapy options, however were rarely used for first-line treatment in T2DM.

Conclusions: Prevalent cases of T2DM more than doubled between 2000 and 2013, while the number of incident cases increased more steadily. Changes in prescribing patterns observed may reflect the impact of national policies and prescribing guidelines on UK primary care.

Keywords: DIABETES & ENDOCRINOLOGY; EPIDEMIOLOGY; PUBLIC HEALTH; THERAPEUTICS.

Figure 1

Prevalence of prescribing of different anti-diabetic medications among all patients with type 2 diabetes on treatment. *Other=Sum of prevalence of Acarbose, GLP-1 analogues, Meglitinides and SGLT-2 inhibitors. **For detailed values of point estimates and CIs, please consult online supplementary appendix 3.

Figure 2

Prevalence of prescribing of different anti-diabetic medications used to initiate treatment in newly diagnosed patients with type 2 diabetes. *Other=Sum of prevalence of Insulins, Thiazolidinediones, Gliptins, Acarbose, GLP-1 analogues, Meglitinides and SGLT-2 inhibitors. **For detailed values of point estimates and CIs, please consult online supplementary appendix 4.

Figure 3

Prevalence of prescribing of different anti-diabetic medications as add-on therapy in patients with type 2 diabetes on metformin. *Other=Sum of prevalence of Insulins, Acarbose, GLP-1 analogues, Meglitinides and SGLT-2 inhibitors. **For detailed figures on point estimates and CIs, please consult online supplementary appendix 5.

Figure 4

Prevalence of prescribing of different anti-diabetic medications as add-on therapy in patients with type 2 diabetes on sulfonylureas. *Other=Sum of prevalence of Acarbose, GLP-1 analogues, Meglitinides and SGLT-2 inhibitors. **For detailed figures on point estimates and CIs, please consult online supplementary appendix 6.