• Article

Trends of use of non‐insulin blood glucose lowering drugs in Europe and USA

Background: New drugs for type 2 diabetes mellitus have been launched since the late 90s (meglitinides, thiazolidinediones (TZD), dipeptidyl peptidase–IV inhibitors (DPP‐4I) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA)). Safety warnings, potential additional indications or local policies could influence the patterns of use.

Objectives: The objective of the study was to describe the use of non‐insulin blood glucose lowering drug (NIBGLD) agents in databases (DBs) participating in the SAFEGUARD project.

Methods: Prevalence (nr of prevalent users/1000 person years [py]) and incidence (nr of new users/1000 py) of use by year and age were estimated in nine DBs (BIFAP (SP), GePaRD (DE), Regional DBs of Puglia and Lombardy, Health Search (IT), IPCI, PHARMO (NL), CPRD (UK) and Medicare (US)) from 1998 to 2012 (DB specific) yearly and by age groups.

Results: Metformin had the highest prevalence (3.9–15.9 users/1000 py in European (EU) DBs and 170.6 users/1000 py in Medicare) and incidence (3.5–8.1/1000 py and 142.0/1000 py, respectively) followed by sulfonylureas. Sulfonylureas were preferred over metformin before 2002. The fixed combination metformin + sulfonylureas was consistently higher in the Italian DBs compared with the rest of DBs (3.0–4.9 vs. 0.1–0.9 users/1000 py) as well as the use of acarbose, which increased after 2009 only in the Italian DBs. The use of sulfonylureas decreased progressively with time, and TZD decreased after 2005–2007 in all DB, especially the incidence and mainly rosiglitazone. Sitagliptin and exenatide were the most frequently used incretin‐based therapies. The use of all drugs increased with age, TZD and DPP‐4I peak at early ages (70–75 years).

Conclusions: Metformin is the most prevalent NIBGLD agent, and its use increased in all DBs over time. The use of DPP‐4I and GLP‐1RA has increased after their introduction, while sulfonylureas and TZD decreased. Some patterns of use are country specific.


Leal, I., Sammon, C., Masclee, GMC., Scotti, L., De Berardis, G., Bezemer, I., ... Romio, S. (2015). Trends of use of non‐insulin blood glucose lowering drugs in Europe and USA. Pharmacoepidemiology and Drug Safety, 24(S1), 106-107. [189]. https://doi.org/10.1002/pds.3838

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