Abstract
BackgroundGuidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease. There exists a wide variation of preference for initial antidiabetes drugs (AD). The current database analysis aimed to understand the real world treatment patterns in drug-naive patients with T2DM in Japan.MethodsWe analyzed data of patients (≥ 18 years) diagnosed with T2DM between October 2012 and September 2016 from the Medical Data Vision, a Diagnosis Procedure Combination database. The primary objective was to determine the proportion of T2DM patients receiving each type of treatment as first-line therapy among the drug-naive cohort.ResultsOf the 436,546 drug-naive patients, 224,761 received their first-line T2DM treatment in the outpatient setting. The mean age of the patient population was 65.6 years at index date. Dipeptidyl peptidase-4 (DPP-4) inhibitor was the most prescribed (56.8%) outpatient AD monotherapy, followed by metformin (15.4%). DPP-4 inhibitors were prescribed over metformin in patients with renal disease (odds ratio [OR]: 4.20; p < 0.0001), coronary heart disease and stroke (OR: 2.22; p < 0.0001). Male (OR: 1.03; p = 0.0026), presence of diabetic complications [retinopathy (OR: 1.33; p < 0.0001), neuropathy (OR: 1.05; p = 0.0037), nephropathy (OR: 1.08; p < 0.0001)] and a high baseline HbA1c (OR: 1.45; p < 0.0001) received treatment intensification during 180 days.ConclusionDPP-4 inhibitors were the most prevalent first-line T2DM treatment followed by metformin in Japan. The findings from this retrospective analysis also support the previously published web survey results and can help understand the real world utilization of T2DM treatment.Trial registration Retrospectively registered
Highlights
Guidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease
Guidelines for T2DM management in Japan provide physicians the discretion to select treatment options based on patient needs and pathophysiology of the disease [2]; this could result in a wide variation in the prescription of antidiabetes drugs (AD) and treatment patterns in clinical practice [5]
Participants A total of 662,678 patients in the Medical Data Vision (MDV) database with a diagnosis of T2DM during the study period were retrieved for the analysis, of which 436,546 (65.9%) patients were adults with T2DM treatment on or after the diagnosis date
Summary
Guidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease. There exists a wide variation of preference for initial antidiabetes drugs (AD). The current database analysis aimed to understand the real world treatment patterns in drug-naive patients with T2DM in Japan. Guidelines for T2DM management in Japan provide physicians the discretion to select treatment options based on patient needs and pathophysiology of the disease [2]; this could result in a wide variation in the prescription of antidiabetes drugs (AD) and treatment patterns in clinical practice [5]. Patients may require an additional oral antidiabetes drug (OAD) in the short term (less than 6 months) after starting the first OAD. There is limited evidence on the characteristics of patients who require additional treatment, and there are no data on physicians’ preferences of the OAD as an add-on therapy
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