Trends in the prescription of anti-diabetic medications in the United Kingdom: a population-based analysis

Purpose Over the last decade, guidelines for the treatment of type 2 diabetes have increasingly favored tighter glycemic control, necessitating the use of more aggressive pharmacological therapy. The objective of this study was to describe trends in the prescription of antidiabetic medications among patients with type 2 diabetes in the United Kingdom (UK). Methods Using the General Practice Research Database, we constructed a cohort of patients with type 2 diabetes. Diabetes was defined as the presence of a diagnosis of diabetes, HbA1c >= 7%, or >= 2 prescriptions for anti-diabetic medications. Analyses were conducted for the full cohort as well as a sub-cohort with incident diabetes. Results Our full cohort involved 67 981 patients and a total of 320 089 patient-years, and our sub-cohort involved 30 234 patients with incident diabetes and 111 890 patient-years. From 2000 to 2006, there was a substantial increase in the prescription rate of anti-diabetic medications. Overall, there were 9.6 prescriptions/patient-year in 2000, and this had increased to 14.8 prescriptions/patient-year in 2006. The greatest relative increase occurred in the prescription of thiazolidinediones. The greatest absolute increase occurred in the prescription of metformin, which surpassed sulfonylureas as the most commonly prescribed anti-diabetic medication among patients with type 2 diabetes in 2002. Among those with incident diabetes, overall prescription rates were 4.6 prescriptions/patient-year in 2000 and 13.6 prescriptions/patient-year in 2006. Conclusions There was a substantial increase between 2000 and 2006 in the UK in the prescription of anti-diabetic medications. This increasingly aggressive pharmacological management is consistent with recent practice guidelines. Copyright (C) 2009 John Wiley & Sons, Ltd.