Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore.

Methods

We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA_1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia.

Results

From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA_1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose.

Conclusion

Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.

摘要

背景

使用降糖药物治疗是对抗2型糖尿病(T2DM)的重要组成部分。在过去的十年中，治疗指南发生了显著的变化。我们报告了在新加坡的一个三级转诊中心里，T2DM患者的药物使用、血糖控制以及严重低血糖发生率随着时间的变化趋势。

方法

我们分析了36924名从2007至2017年间在新加坡综合医院就诊的T2DM患者数据。每年按年龄、性别以及种族-标准化后的患者比例使用logistic回归进行分析，纳入分析的患者包括(a)所处方的每类降糖药物，(b)正在使用的各种降糖治疗方案，以及(c)HbA1c小于6%、6%至小于7%、7%至小于8%、8%至小于9%，或者9%至更高水平。采用泊松回归法来评估严重低血糖的标准化发生率。

结果

从2007至2017年，二甲双胍(从45.9%至59.6%)与胰岛素(从24.4%至57.9%)的使用率增加了，而磺脲类药物的使用率下降了(从52.0%至44.9%)(全部P < 0.001)。从2008至2017年与从2012至2017年，二肽基肽酶-4抑制剂(从1.2%至31.2%)与钠-葡萄糖共转运体-2抑制剂(从0.5%至7.4%)的使用率也增加(全部P < 0.001)。有更多比例(从17.3%至46.0%)的患者处方是联合使用胰岛素与口服药物治疗(P < 0.001)。HbA1c大于等于8%的患者比例(从33.7%至36.0%)增加了(P < 0.001)。严重低血糖的发生率也升高了(从5.0至8.4次/每100名患者/年，P < 0.001)。

结论

在过去的11年中，药物的使用模式发生了显著的变化，变得愈来愈倾向于选择新的治疗药物。血糖控制情况保持稳定，但是严重低血糖的发生率有所上升。在推断因果关系之前需要进一步的分析。

CONFLICTS OF INTEREST

The authors have no conflicts of interest to disclose.

Supporting Information

Filename

Description

jdb12886-sup-0001-AppendixS1.docxWord 2007 document , 94.2 KB

TABLE S1A Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (18-44 years) prescribed with each class of glucose-lowering agent (n = 6330)

TABLE S1B Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (45-64 years) prescribed with each class of glucose-lowering agent (n = 42 363)

TABLE S1C Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (65-74 years) prescribed with each class of glucose-lowering agent (n = 29 628)

TABLE S1D Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (≥75 years) prescribed with each class of glucose-lowering agent (n = 23 832)

TABLE S2A Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (Chinese) prescribed with each class of glucose-lowering agent (n = 68 424)

TABLE S2B Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (Malays) prescribed with each class of glucose-lowering agent (n = 14 515)

TABLE S2C Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (Indians) prescribed with each class of glucose-lowering agent (n = 15 384)

TABLE S2D Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (others) prescribed with each class of glucose-lowering agent (n = 3830)

TABLE S3A Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (no comorbidity) prescribed with each class of glucose-lowering agent (n = 73 044)

TABLE S3B Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (1 comorbidity) prescribed with each class of glucose-lowering agent (n = 21 672)

TABLE S3C Age-, sex- and racially-standardized proportions of type 2 diabetes mellitus patients (≥2 comorbidities) prescribed with each class of glucose-lowering agent (n = 7437)

TABLE S4A Age-, sex- and racially-standardized proportions of patients (18-44 years) under each drug regimen category (n = 5856)

TABLE S4B Age-, sex- and racially-standardized proportions of patients (45-64 years) under each drug regimen category (n = 38 954)

TABLE S4C Age-, sex- and racially-standardized proportions of patients (65-74 years) under each drug regimen category (n = 27 223)

TABLE S4D Age-, sex- and racially-standardized proportions of patients (≥75 years) under each drug regimen category (n = 21 885)

TABLE S5A Age-, sex- and racially-standardized proportions of patients (Chinese) under each drug regimen category (n = 62 558)

TABLE S5B Age-, sex- and racially-standardized proportions of patients (Malays) under each drug regimen category (n = 13 542)

TABLE S5C Age-, sex- and racially-standardized proportions of patients (Indians) under each drug regimen category (n = 14 404)

TABLE S5D Age-, sex- and racially-standardized proportions of patients (others) under each drug regimen category (n = 3524)

TABLE S6A Age-, sex- and racially-standardized proportions of patients (no comorbidity) under each drug regimen category (n = 65 865)

TABLE S6B Age-, sex- and racially-standardized proportions of patients (1 comorbidity) under each drug regimen category (n = 20 807)

TABLE S6C Age-, sex- and racially-standardized proportions of patients (≥2 comorbidities) under each drug regimen category (n = 7246)

TABLE S7A Age-, sex- and racially-standardized proportions of patients (18-44 years) under each HbA_1c category (n = 4264)

TABLE S7B Age-, sex- and racially-standardized proportions of patients (45-64 years) under each HbA_1c category (n = 23 351)

TABLE S7C Age-, sex- and racially-standardized proportions of patients (6574 years) under each HbA_1c category (n = 14 086)

TABLE S7D Age-, sex- and racially-standardized proportions of patients (≥75 years) under each HbA_1c category (n = 9132)

TABLE S8A Age-, sex- and racially-standardized proportions of patients (Chinese) under each HbA_1c category (n = 33 875)

TABLE S8B Age-, sex- and racially-standardized proportions of patients (Malays) under each HbA_1c category (n = 6723)

TABLE S8C Age-, sex- and racially-standardized proportions of patients (Indians) under each HbA_1c category (n = 8195)

TABLE S8D Age-, sex- and racially-standardized proportions of patients (others) under each HbA_1c category (n = 2040)

TABLE S9A Age-, sex- and racially-standardized proportions of patients (no comorbidity) under each HbA_1c category (n = 39 412)

TABLE S9B Age-, sex- and racially-standardized proportions of patients (1 comorbidity) under each HbA_1c category (n = 8481)

TABLE S9C Age-, sex- and racially-standardized proportions of patients (≥2 comorbidities) under each HbA_1c category (n = 2940)

TABLE S10A Age-, sex- and racially-standardized rate of hypoglycemia (per 100 patient years) by age from 2007 to 2017

Table S10B Age-, sex- and racially-standardized rate of hypoglycemia (per 100 patient years) by racially from 2007 to 2017

TABLE S10C Age-, sex- and racially-standardized rate of hypoglycemia (per 100 patient years) by comorbidities from 2007 to 2017

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume11, Issue7

July 2019

Pages 573-581

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Epidemiology & Genetics

Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017

从2007至2017年在新加坡的一个三级转诊中心内2型糖尿病患者的药物使用、血糖控制以及预后的变化趋势

Abstract

Background

Methods

Results

Conclusion

摘要

背景

方法

结果

结论

CONFLICTS OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

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Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017

从2007至2017年在新加坡的一个三级转诊中心内2型糖尿病患者的药物使用、血糖控制以及预后的变化趋势

Abstract

Background

Methods

Results

Conclusion

摘要

背景

方法

结果

结论

CONFLICTS OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

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