Abstract
BackgroundThere are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years. The goals of this study were to describe the glycemic medication profiles in a cohort of adult patients enrolled in primary care, to compare the regimens with measures of glycemic control, and to describe potential contraindicated regimens.MethodsOne thousand and six subjects with diabetes cared for in community practices in the Northeast were interviewed at home at the time of enrollment in a trial of a diabetes decision support system. Laboratory data were obtained directly from the clinical laboratory. Current medications were obtained by direct observation of medication containers by a research assistant.ResultsThe median age of subjects was 63 years; 54% were female. The mean A1C was 7.1%, with 60% of subjects in excellent glycemic control (A1C < 7%). Ninety percent of patients were taking 2 or fewer medications for glycemic control, with a range of 0 to 4 medications. Insulin was used by 18%. As the number of diabetes medications increased from 0 to 4, the A1C increased from 6.5% to 9.2% (p < 0.001). The association between glycemic control and number of glycemic medications was confirmed using logistic regression, controlling for potential confounders. Almost 20% of subjects on metformin or thiazolidenediones had potential contraindications to these medications.ConclusionPatients with diabetes cared for in primary care are on a wide variety of medication combinations for glycemic control, though most are on two or fewer medications. A greater number of diabetes medications is associated with poorer glycemic control, reflecting the limitations of current pharmacotherapy. One quarter of patients are on glycemic medications with potential contraindications.
Highlights
There are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years
While there are a wide variety of options for pharmacotherapy of diabetes, there is no one recommended regimen [7]
Mental and physical functioning as measured by the SF-12 Mental Component Summary and Physical Component Summary scales were similar to national norms for patients with diabetes [15]
Summary
There are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years. 1990s, the number of primary care visits among patients with diabetes listing at least 5 prescription medications increased from 18% to 30%, and the proportion of visits in which more that one medication for glycemic control (page number not for citation purposes). New classes of medications have been introduced since 1999, including the thiazolidenediones (TZDs), acarbose, and both ultra-short acting and 24-hour insulin analogues. It is not clear how the addition of these new medication classes has changed the landscape of pharmacotherapy of diabetes
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