Drug treatment practice in diabetes mellitus during 1975-1994 : Population-based pharmacoepidemiological studies

Sammanfattning: The aims of these studies were to investigate pharmacological practice in diabetes mellitus in defined populations in Sweden and in France, the effects on glycaemic control and the change of hypoglycaemic drug treatment practice in Sweden during 1975-1994.Data from diabetic subjects were obtained from the Tierp Study Database during 1975 - 1994 by record-linkage of subjects with diabetes diagnosis at the primary health care centre and diabetes drugs purchased at the local pharmacies in Tierp. Data from diabetic subjects in Gotland. Skellefteå and France were obtained from drug sales statistics or laboratory test files.Even though only 2.8% of the general population were diabetes subjects they accounted for 10.2% of all drug prescriptions. Diabetic subjects used more of 9 out of 15 pharmacological groups than non-diabetic subjects, mostly accounted for by cardiovascular drugs. The higher use of cardiovascular drugs was most pronounced among those who were treated with oral hypoglycaemic drugs or on diet only.Oral hypoglycaemic drug treatment and glycaemic control in diabetic subjects was determined in three geographically areas, characterised by high (Gotland), average (Tierp) and low (Skellefteå) utilisation of hypoglycaemic drugs. Heavy drug use was associated with low HbAlc levels and high BMI. Regardless of treatment intensity, less than 20% of the patients in all three areas were within the defined standards of good overall metabolic control (HbAlc <7% and BMI <27 (males) or <25 (females).Oral hypoglycaemic drug treatment and glycaemic control in the three Swedish study populations combined was compared with a similar French population. Despite varying pharmacological practices in the two samples, only a minority of the patients met a predefined standard of good overall diabetic control.During 1975 - 1994 substantial changes in pharmacological practice towards a more intensive therapy took place. A shift from "diet only" via oral treatment to more insulin was found especially in the elderly where insulin use increased ten-fold from 1975-81 to 1990-94. The diabetes treatment practice followed issued guidelines and changes of the guidelines fairly closely.