Ajiboye O, Segal J B
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Clin Pharm Ther. 2017 Jun;42(3):311-317. doi: 10.1111/jcpt.12516. Epub 2017 Mar 15.
The prevalence of diabetic nephropathy continues to rise and it remains a strong predictor of morbidity and mortality in diabetic patients. Patients diagnosed with diabetic nephropathy are actively excluded from most trials involving diabetic medications and it is important to understand the prescription patterns in this subset of patients with diabetes.
Using the IMS Health's National Disease and Therapeutic Index, we analysed the medication prescription patterns for six classes of medications from 2010 to 2014 among patients, 35 years or older, with diabetic nephropathy.
Annual office visits increased from 772 860 (95% confidence interval (CI), 755, 470-790, 249) in 2010 to 1 868 618 (95% CI, 1 834 422-1 902 814) in 2013 and declined to 830 596 (95% CI, 809 167-852 025) in 2014. Sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were the most frequently used of the four classes of diabetic medications included in this study. DPP-4 inhibitors use increased gradually and was used in 54% (95% CI 49-58) of treatment visits by the last quarter of 2014. Across these years, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEIs and ARBs) were prescribed in the majority of treatment visits with peaks above 90%. However, there were some periods when utilization of these antihypertensives was low.
Significant increases occurred in the uptake of new diabetic medications; DPP-4 inhibitors and SGLT-2 inhibitors and in the utilization of ACEIs and ARBs compared to the findings reported in other studies with increased complexity in the treatment of patients with diabetic nephropathy. Improved and continued used of these medications may be beneficial in improving patient outcomes.
糖尿病肾病的患病率持续上升，并且仍然是糖尿病患者发病和死亡的有力预测指标。大多数涉及糖尿病药物的试验都主动排除了被诊断为糖尿病肾病的患者，因此了解这部分糖尿病患者的处方模式很重要。
我们使用艾美仕市场研究公司的全国疾病和治疗指数，分析了2010年至2014年期间35岁及以上糖尿病肾病患者六类药物的处方模式。
年度门诊就诊次数从2010年的772860次（95%置信区间（CI），755470 - 790249）增加到2013年的1868618次（95%CI，1834422 - 1902814），并在2014年降至830596次（95%CI，809167 - 852025）。磺脲类药物和二肽基肽酶 - 4抑制剂（DPP - 4抑制剂）是本研究中包含的四类糖尿病药物中使用最频繁的。DPP - 4抑制剂的使用逐渐增加，到2014年最后一个季度，在54%（95%CI 49 - 58）的治疗就诊中被使用。在这些年里，大多数治疗就诊都开具了血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂（ACEI和ARB），峰值超过90%。然而，这些抗高血压药物在某些时期的使用量较低。
与其他研究报告的结果相比，糖尿病肾病患者治疗复杂性增加，新型糖尿病药物（DPP - 4抑制剂和SGLT - 2抑制剂）的使用显著增加，ACEI和ARB的使用也有所增加。更好地持续使用这些药物可能有利于改善患者的治疗效果。
