• A S Geier, I Wellmann, J Wellmann, H Kajüter, O Heidinger, G Hempel, and H W Hense.
• Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany. Electronic address: ageier@uni-muenster.de.
• Diabetes Res. Clin. Pract. 2014 Oct 1; 106 (1): 73-80.

AimsWe evaluated the patterns and determinants that influence the selection, timing and duration of first-line antihyperglycaemic drug (AHD) treatment in patients with type 2 diabetes in Germany, focusing specifically on treatment-naive AHD initiators.MethodsPharmacy dispensing claims data were linked with a cohort of patients newly enrolled in a German Disease Management Program for type 2 diabetes (DMP-DM2) between 2003 and 2009. We examined uptake of first-line pharmacotherapy in previously unmedicated patients and identified predictors of receiving AHD therapy in general and metformin in particular using multivariable regression analyses.ResultsThere were 27,138 unmedicated patients with type 2 diabetes and 47.0% of them were started on AHD treatment within 5 years after enrollment. Initial severity of diabetes was the major predictor of receiving first-line pharmacotherapy. Metformin accounted for 63% of newly prescribed AHD in 2003 and more than 80% in 2009 while sulfonylureas accounted for only 10%. Initiating metformin as first-line AHD was associated with younger age, higher BMI, lower HbA1c, and shorter diabetes duration (multivariate p<0.001 for all). Therapy switch or step-up was less frequent among metformin initiators than sulfonylurea initiators.ConclusionsThe majority of patients were not started on AHD therapy within 5 years after enrollment. In line with recent therapy guidelines, current first-line antihyperglycaemic treatment was increasingly based on metformin. AHD initiators started on sulfonylurea were generally more advanced in their disease and were started later on primary pharmacotherapy.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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