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Pharmacological treatment initiation for type 2 diabetes in Australia: are the guidelines being followed?

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dc.contributor.authorWood, S.J.
dc.contributor.authorMagliano, D.J.
dc.contributor.authorBell, J.S.
dc.contributor.authorShaw, J.E.
dc.contributor.authorKeen, C.S.
dc.contributor.authorIlomaki, J.
dc.date.issued2020
dc.description.abstractAim: To determine the patterns and predictors of pharmacological treatment initiation for type 2 diabetes and whether treatment initiation is consistent with Australian clinical practice guidelines that recommend metformin monotherapy. Methods: Individuals aged 40-99 years initiating a non-insulin type 2 diabetes medication between July 2013 and February 2018 were identified from a 10% random national sample of pharmacy dispensing data. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the predictors of initiating sulfonylurea monotherapy, non-guideline monotherapy and combination therapy compared with metformin monotherapy. Predictors included age, sex, initiation year and comorbidities determined using the Rx-Risk comorbidity index. Results: Of the 47 860 initiators, [47% women, mean age 60.7 (sd 12.1) years], 85.8%, 4.6%, 1.9% and 7.7% received metformin monotherapy, sulfonylurea monotherapy, non-guideline monotherapy and combination therapy, respectively. Increasing age was associated with increasing odds of initiating sulfonylurea monotherapy and non-guideline monotherapy. Combination therapy initiation was less likely in women (OR 0.74, 95% CI 0.69-0.79) and people with more comorbidities (e.g. OR 0.36, 95% CI 0.29-0.44 for seven or more comorbidities vs. no comorbidities) but more likely in congestive heart failure (OR 1.42, 95% CI 1.22-1.65), cerebrovascular disease (OR 1.50, 95% CI 1.32-1.69) and dyslipidaemia (OR 1.29, 95% CI 1.19-1.40). Conclusion: Treatment initiation in Australia is largely consistent with clinical practice guidelines, with 86% of individuals initiating metformin monotherapy. Initiation on combination therapy was more common in men and in those with fewer comorbidities.
dc.identifier.citationDiabetic Medicine, 2020; 37(8):1367-1373
dc.identifier.doi10.1111/dme.14149
dc.identifier.issn0742-3071
dc.identifier.issn1464-5491
dc.identifier.urihttps://hdl.handle.net/11541.2/140243
dc.language.isoen
dc.publisherWiley-Blackwell Publishing
dc.relation.fundingNHMRC 1072137
dc.relation.fundingNHMRC 1079438
dc.relation.fundingNHMRC 1140298
dc.relation.fundingAustralian Government
dc.rightsCopyright 2019 Diabetes
dc.source.urihttps://doi.org/10.1111/dme.14149
dc.subjecttype 2 diabetes
dc.subjectAustralian clinical practice guidelines
dc.subjecttreatment initiation
dc.titlePharmacological treatment initiation for type 2 diabetes in Australia: are the guidelines being followed?
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916331611701831

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