Department of Clinical Pharmacy, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands.
Diabetes Res Clin Pract. 2021 Jun;176:108828. doi: 10.1016/j.diabres.2021.108828. Epub 2021 Apr 21.
To identify patient-specific factors associated with early metformin treatment modification among type 2 diabetes patients before and after implementation of the updated 2015 NICE (National Institute for Health and Care Excellence) guideline.
We conducted a population-based cohort study using data from the Clinical Practice Research Datalink GOLD database (2009-2016). Patients ≥ 18 years, newly treated with metformin only, during the period of valid data collection were included. The first prescription defined start of follow-up. Determinants of treatment modification in two cohorts (before and after implementation of the updated guideline) were studied by time-dependent Cox proportional hazards regression.
After implementation of the updated guideline, patients were less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% vs 2.2%) and more likely to receive dipeptidyl peptidase-4 inhibitors (15.8% vs 27.1%) or sodium-glucose cotransporter-2 inhibitors (0.8% vs 9.9%). Some determinants influenced general practitioners' prescribing differently after implementation of the updated guideline compared to before, including a high body mass index and heart failure.
Our results indicate that a first step towards tailored prescribing has been made. However, not all determinants that are important to consider when prescribing second-line glucose-lowering agents were of influence on general practitioners' prescribing.
在更新后的 2015 年 NICE（英国国家健康与临床优化研究所）指南实施前后，确定与 2 型糖尿病患者在开始使用二甲双胍治疗前和治疗后早期调整药物相关的患者特定因素。
我们使用来自临床实践研究数据链接 GOLD 数据库（2009-2016 年）的数据进行了一项基于人群的队列研究。纳入了在有效数据采集期间仅接受二甲双胍新治疗且年龄≥18 岁的患者。首次处方定义为随访开始。通过时间依赖性 Cox 比例风险回归研究了两个队列（在更新指南实施前后）中治疗调整的决定因素。
在更新指南实施后，患者接受磺脲类药物（62.3%比 41.3%）或噻唑烷二酮类药物（4.7%比 2.2%）的可能性降低，而接受二肽基肽酶-4 抑制剂（15.8%比 27.1%）或钠-葡萄糖协同转运蛋白-2 抑制剂（0.8%比 9.9%）的可能性增加。与更新指南实施前相比，一些决定因素对全科医生的处方产生了不同的影响，包括高体重指数和心力衰竭。
我们的结果表明，已经朝着量身定制的处方迈出了第一步。然而，并非所有在开具二线降糖药物时需要考虑的重要决定因素都对全科医生的处方有影响。
