Long-Term Patterns of Antidiabetic Medication Use in Patients with Type 2 Diabetes

BACKGROUND: This study aimed to investigate the patterns of use of antidiabetic medication among patients with newly diagnosed type 2 diabetes mellitus (T2DM), focusing on the comparison in glycemic control between sulfonylureas and metformin. MATERIAL/METHODS: Data from patients newly diagnosed and treated for T2DM between 2011 and 2014, who were ≥18 years of age were obtained from the Yinzhou Regional Health Care Database, and patterns of medication and glycemic control were analyzed. The Poisson probability distribution was used to determine the rate ratio (incidence density ratio) of uncontrolled hyperglycemia between sulfonylureas and metformin. Cox regression analysis was used to determine the association between initial treatment with sulfonylureas and metformin and the requirement for additional medications. RESULTS: Of the 4,017 patients included in the study, 33.58% began treatment with sulfonylureas and 20.41% began treatment with metformin, and during follow-up, 21.13% and 22.68%, respectively were treated with a second drug. After adjustment for body mass index (BMI) and fasting blood glucose (FBG), the rate ratio of uncontrolled blood glucose for sulfonylurea monotherapy compared with metformin monotherapy was 1.30 (95% CI, 1.17–1.45). Patients who began treatment with sulfonylureas were 18% less likely to progress to dual medication compared with metformin (HR=0.82; 95% CI, 0.68–0.99). CONCLUSIONS: Sulfonylurea monotherapy was the most common initial treatment for patients with newly diagnosed T2DM and was associated with an increased risk of uncontrolled hyperglycemia, but patients were less likely to receive additional drugs when compared with patients initially treated with metformin monotherapy.