Prescribing Of Antidiabetes Therapies in Ireland

Nur Lisa Zaharan, Kathleen Bennett, John Feely. Trinity College Dublin, Dublin, Ireland.

Background: Diabetes mellitus (DM) prevalence is on the increase. Hypoglycaemic agents are prescribed to achieve better glycaemic controls in both type 1 (T1DM) and type 2 DM (T2DM) patients.

Aims:

1) To determine the prevalence of treated DM in adult population in Ireland

2) To examine the hypoglycaemic agents utilization trends over a 6-year period

Methods: The HSE-Primary Care Reimbursement Services prescribing database was used to identify patients aged ≥16 years prescribed hypoglycaemic agents from 1st January 2003 to 31st December 2008 (n=117699) in Ireland. T1DM patients were those prescribed insulin only while T2DM were those prescribed oral hypoglycaemic agents; alone or combined with insulin. Prevalence was determined using the projected national population. Linear test was used to examine prescribing trends. SAS (SAS 9.1, N.Y) statistical software was used for analysis.

Results: Overall, the prevalence of treated DM in adults increased from 2.1% in 2003 to 3.2% in 2008 (p<0.0001). A significant increase in age-adjusted prevalence of T1DM (0.4% in 2003; 0.6% in 2008) and T2DM (1.4% in 2003; 2.2% in 2008) was observed (p<0.0001).

Insulin analogues (67%) were rapidly replacing human insulin (50%) in T1DM patients (p<0.001). There was an increase in the prescribing of fast-acting (71%) and long-acting insulin (66%), (p<0.001). The insulin analogues of choice were insulin aspart (54%) followed by insulin glargine (35%).

Increased rate of metformin (74%) but decreased rate of sulphonylureas (60%) prescribing was observed (p<0.001). Prescribing for glitazones (8%) decreased after 2005 (p<0.001). Prescribing of oral combination therapies (44%) and insulin (11%) also increased in T2DM patients (p<0.001).

Conclusion: The prevalence of diabetes in Ireland is on the increase. Although expensive, insulin analogues are gaining popularity in T1DM patients. The prescribing for T2DM patients is in line with clinical guidelines.