The pattern of prescribing of glucose modulating agents for type 2 diabetes in general practices in England 2016/17.

BACKGROUND: In the financial year 2016/17 there were 52.0 million items prescribed for diabetes at a total net ingredient cost of £983.7 million - up from 28.9 million prescription items and £572.4 million in 2006/07. Anti-diabetes drugs (British National Formulary section 6.1.2) make up 45.1 per cent of the total £983.7 million net ingredient cost of drugs used in diabetes and account for 72.0 per cent of prescription items for all diabetes prescribing. METHODS: We examined the way that agents licensed to treat type 2 diabetes were used across GP practices in England in the year 2016/2017. Analysis was at a GP practice level not at the level of patient data. RESULTS: Annual prescribing costs / patient / medication type for monotherapy varied considerable from £11/year for gliclazide and glimepiride to £885/year for Liraglutide. The use of SGLT-2i agents grew strongly at 70% per annum to around 100,000 DDD with prescriptions seen in 95% of GP practices. Liraglutide expenditure (11% of total) was high for a relatively small number of patients (1.3% of Defined Daily Doses), with still significant spend on exenatide. Liraglutide use significantly exceeded that of other glucagon-like peptide-1 (GLP-1) agonists. CONCLUSIONS: Our work demonstrates the significant cost of medication to modulate tissue glucose levels in type 2 diabetes and the dominance of some non-generic preparations in terms of number of prescriptions and overall spend. There are some older sulphonylureas in use, which should not generally be prescribed. Regular audit of patient treatment at a general practice level will ensure appropriate targeted use of licensed medications and of their cost effectiveness.

[Therapy objectives and daily practice--to which extent are blood sugar target values accessible in daily practice?]. / Therapierichtlinien und Praxisalltag--Sind die Blutzucker-Zielwerte im Praxisalltag erreichbar?

The healthcare sector is characterized at present by increasingly ambitious therapeutic objectives and rising healthcare costs. The aim of the Swiss study was to explore ways of achieving these therapeutic objectives in the present healthcare environment via the use of cost-effective antidiabetic agents. With a therapeutic regimen based on gliclazide, it was possible to reduce fasting blood glucose levels to below 7.0 mol/l in 70% of the 94 type 2 diabetics included in the study. Fasting blood glucose levels returned to normal in 80% of the women taking part of the study; the normalization rate was significantly higher in this group than in the study population as a whole. The target HbA1c -value was attained in 7% of both the patient group receiving gliclazide monotherapy and the group receiving gliclazide in combination with metformin. Weight reduction was observed in all the treatment groups. Some 86% of the patients experienced an improvement in life quality as a result of the more effective management of their diabetes. The tolerability of the treatment was very high. A total of two episodes of mild symptomatic hypoglycemia were recorded. The per diem costs of gliclazide-based treatment are in the range of 1-2 Swiss francs.