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. 2016 Oct 5;6(10):e012463.
doi: 10.1136/bmjopen-2016-012463.

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study

Manel Mata-Cases  1 , Josep Franch-Nadal  2 , Jordi Real  3 , Dídac Mauricio  4
Affiliations

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study

Manel Mata-Cases et al. BMJ Open. .

Abstract

Objectives: To assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM).

Design: Cross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database.

Setting: Primary healthcare centres, including the entire population attended by the Institut Català de la Salut in Catalonia, Spain, from 2007 to 2013.

Participants: Patients aged 31-90 years with a diagnosis of T2DM.

Results: The number of registered patients with T2DM in the database was 257 072 in 2007, increasing up to 343 969 in 2013. The proportion of patients not pharmacologically treated decreased by 9.7% (95% CI -9.48% to -9.92%), while there was an increase in the percentage of patients on monotherapy (4.4% increase; 95% CI 4.16% to 4.64%), combination therapy (2.8% increase; 95% CI 2.58% to 3.02%), and insulin alone or in combination (increasing 2.5%; 95% CI 2.2% to 2.8%). The use of metformin and dipeptidyl peptidase-IV inhibitors increased gradually, while sulfonylureas, glitazones and α-glucosidase inhibitors decreased. The use of glinides remained stable, and the use of glucagon-like peptide-1 receptor agonists was still marginal. Regarding glycaemic control, there were no relevant differences across years: mean glycated haemoglobin (HbA1c) value was around 7.2%; the percentage of patients reaching an HbA1c≤7% target ranged between 52.2% and 55.6%; and those attaining their individualised target from 72.8% to 75.7%.

Conclusions: Although the proportion of patients under pharmacological treatment increased substantially over time and there was an increase in the use of combination therapies, there have not been relevant changes in glycaemic control during the 2007-2013 period in Catalonia.

Keywords: PRIMARY CARE; Type 2 diabetes mellitus; antidiabetics; glycemic control; prescription.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Percentage of patients with T2DM at each step of antidiabetic treatment. NIAD, non-insulin antidiabetic drug; T2DM, type 2 diabetes mellitus.
Figure 2
Figure 2
Percentage of patients having non-insulin antidiabetic drug prescriptions (alone or in combination). AGI, α-glucosidase inhibitors; DPP4i, dipeptidyl peptidase-IV inhibitors; GLP-1ra, glucagon-like peptide-1 receptor agonists; T2DM, type 2 diabetes mellitus.
Figure 3
Figure 3
Percentage of patients achieving glycaemic control according to HbA1c intervals. HbA1c, glycated haemoglobin; T2DM, type 2 diabetes mellitus.
Figure 4
Figure 4
Evolution of mean HbA1c according to the different steps of antidiabetic treatment and T2DM duration. HbA1c, glycated haemoglobin; NIAD, non-insulin antidiabetic drug; T2DM, type 2 diabetes mellitus.
See this image and copyright information in PMC

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