Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017

Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore.We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia.From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose.Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.背景: 使用降糖药物治疗是对抗2型糖尿病(T2DM)的重要组成部分。在过去的十年中，治疗指南发生了显著的变化。我们报告了在新加坡的一个三级转诊中心里，T2DM患者的药物使用、血糖控制以及严重低血糖发生率随着时间的变化趋势。 方法: 我们分析了36924名从2007至2017年间在新加坡综合医院就诊的T2DM患者数据。每年按年龄、性别以及种族-标准化后的患者比例使用logistic回归进行分析，纳入分析的患者包括(a)所处方的每类降糖药物，(b)正在使用的各种降糖治疗方案，以及(c)HbA1c小于6%、6%至小于7%、7%至小于8%、8%至小于9%，或者9%至更高水平。采用泊松回归法来评估严重低血糖的标准化发生率。 结果: 从2007至2017年，二甲双胍(从45.9%至59.6%)与胰岛素(从24.4%至57.9%)的使用率增加了，而磺脲类药物的使用率下降了(从52.0%至44.9%)(全部P < 0.001)。从2008至2017年与从2012至2017年，二肽基肽酶-4抑制剂(从1.2%至31.2%)与钠-葡萄糖共转运体-2抑制剂(从0.5%至7.4%)的使用率也增加(全部P < 0.001)。有更多比例(从17.3%至46.0%)的患者处方是联合使用胰岛素与口服药物治疗(P < 0.001)。HbA1c大于等于8%的患者比例(从33.7%至36.0%)增加了(P < 0.001)。严重低血糖的发生率也升高了(从5.0至8.4次/每100名患者/年，P < 0.001)。 结论: 在过去的11年中，药物的使用模式发生了显著的变化，变得愈来愈倾向于选择新的治疗药物。血糖控制情况保持稳定，但是严重低血糖的发生率有所上升。在推断因果关系之前需要进一步的分析。.