Abstract
BackgroundLittle is known about prescription patterns of expensive non-recommended newer long-acting insulins (glargine 300 U/mL and degludec) for patients with type 2 diabetes mellitus (T2DM).AimTo identify practice variation in, and practice- and patient-related characteristics associated with, the prescription of newer long-acting insulins to patients with T2DM in primary care.Design and settingA retrospective cohort study in Dutch general practices (Nivel Primary Care Database).MethodA first prescription for intermediate or long-acting insulins in 2018 was identified in patients aged ≥40 years using other T2DM drugs. Per practice, the median percentage and interquartile range (IQR) of patients with newer insulin prescriptions were calculated. Multilevel logistic regression models were constructed to calculate intraclass correlation coefficients (ICCs) and quantify the association of patient and practice characteristics with prescriptions for newer insulins (odds ratios [ORs] and 95% confidence intervals [CIs]).ResultsIn total, 7757 patients with prescriptions for intermediate or long-acting insulins from 282 general practices were identified. A median percentage of 21.2% (IQR 12.5–36.4%) of all patients prescribed intermediate or long-acting insulins per practice received a prescription for newer insulins. After multilevel modelling, the ICC decreased from 20% to 19%. Female sex (OR 0.77, 95% CI = 0.69 to 0.87), age ≥86 years compared with 40–55 years (OR 0.22, 95% CI = 0.15 to 0.34), prescriptions for metformin (OR 0.66, 95% CI = 0.53 to 0.82), sulfonylurea (OR 0.58, 95% CI = 0.51 to 0.66), or other newer T2DM drugs (OR 3.10, 95% CI = 2.63 to 3.66), and dispensing practices (OR 1.78, 95% CI = 1.03 to 3.10) were associated with the prescription of newer insulins.ConclusionThe inter-practice variation in the prescription of newer insulins is large and could only be partially explained by patient- and practice-related differences. This indicates substantial opportunities for improvement.
Highlights
New medicines are often expensive and have a risk-benefit ratio that has not been fully elucidated yet [1, 2]
Our study shows that approximately 25% of all type 2 diabetes mellitus (T2DM) patients with intermediate or long-acting insulins received a prescription for one of the newer insulins
Clinical guidelines usually do not recommend their use, especially if less expensive and evidence based alternatives are available [3]. This is reflected in the most current type 2 diabetes mellitus (T2DM) guidelines, which do not recommend the use of insulin glargine 300 U/ml and insulin degludec [4-6]
Summary
New medicines are often expensive and have a risk-benefit ratio that has not been fully elucidated yet [1, 2]. Clinical guidelines usually do not recommend their use, especially if less expensive and evidence based alternatives are available [3] This is reflected in the most current type 2 diabetes mellitus (T2DM) guidelines, which do not recommend the use of insulin glargine 300 U/ml and insulin degludec [4-6]. A number of patient and practice characteristics have been positively associated with the prescription of new medicines, including male sex, younger age and practice location [11, 12]. Whether these factors apply for the prescription of newer insulins is unknown. Little is known about the prescription of expensive non-recommended newer long-acting insulins (glargine 300 U/ml and degludec) for type 2 diabetes mellitus (T2DM) patients
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