First-Choice Medication for Diabetes: Are Best-Practice Messages Getting Through?

Margaret Williamson*, Linda Klein, Magnolia Cardona

*Corresponding author for this work

Research output: Contribution to journalMeeting AbstractResearchpeer-review


Background: There are established guidelines in Australia for the pharmaceutical management of Type 2 diabetes. With the increase in the number of new oral hypoglycaemic agents and types of insulin approved for use since 2003, NPS has implemented educational visiting programs in general practice to promote the optimal use of first line therapy among patients with Type 2 diabetes.

: To investigate if prescribing of first ‐ line therapy for diabetes was consistent with guidelines and to assess which demographic characteristics are associated with best practice.

Methods: Data were obtained for all concessional patients (i.e. those eligible for the maximum subsidy for medicines) who were dispensed any oral diabetes medicines between July 2003 ‐ ‐ December 2008 under the Australian Pharmaceutical Benefits Scheme. Each record of a prescription filled contained an anonymous PIN allowing linking of individual patients. An extensive data cleaning process was conducted. Concessional patients who had received no diabetes or cardiovascular medicines in the previous 12 months were defined as newly diagnosed, and a cohort was created to identify first line therapy. Logistic regression was used to assess the association between best practice and patient demographics.

166,526 concessional patients dispensed oral diabetes medicine were eligible for analysis. Metformin, (single agent) was the most common diabetes medicine of first choice between 2004 and 2008. The proportion of patients using Metformin increased from 68.2% to 80.5%. Those using sulfonylureas alone decreased from 26.3% to 13.7%. These trends were confirmed using logistic regression. Combinations were present but in less than 6% of these patients. As might be expected, age was inversely associated with a prescription of metformin alone (OR=0.6 to 0.3). Females and people living in regional areas were more likely to be prescribed metformin alone than males or those living in urban or remote areas.

Conclusions: These findings indicate that between 2004 and 2008 there was increase in the use of metformin (single agent) as first ‐ line oral diabetes therapy. This is consistent with the best ‐ practice messages promoted at the time.
Original languageEnglish
Article number675
Pages (from-to)293
Number of pages1
JournalPharmacoepidemiology and Drug Safety
Issue numberS1
Publication statusPublished - Aug 2011
Externally publishedYes


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