Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.18/7180 |
Resumo: | Introduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists. Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed. Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%). Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists. Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists. |
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Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice NetworkEscolhas Terapêuticas Iniciais para a Diabetes Tipo 2 na Rede de Médicos SentinelaDiabetes MellitusDiabetes Mellitus, Type 2Cross-Sectional StudiesDipeptidyl-Peptidase IV InhibitorsDisease NotificationFamily PracticeFemaleHumansHypoglycemic AgentsInsulinLife StyleMaleMetforminMiddle AgedAgedPractice Patterns, Physicians'Diabetes Mellitus Tiye 2/Drug TherapyPrimary Health CareSentinel SurveillancePortugalDiabetes Mellitus Tipe 2/tratamentoHipoglicemiantesCuidados de SaúdeCuidados de Saúde PrimáriosVigilância de Evento SentinelaMédicos-sentinelaIntroduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists. Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed. Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%). Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists. Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists.Introdução: A diabetes tipo 2 tem um peso significativo nas despesas com medicamentos. Determinámos a proporção de novos doentes que iniciaram tratamento com cada classe de antidiabéticos, se o tratamento foi iniciado pelos médicos de família, se estes alteram as prescrições de outros médicos e comparámos padrões de prescrição de médicos de família e outros especialistas. Material e Métodos: Estudo transversal aninhado em coorte na Rede de Médicos Sentinela. Entre 2014 e 2015 casos incidentes de diabetes tipo 2 foram notificados, reportando o tratamento, quem fez a prescrição inicial e se tratamentos iniciados por outros médicos foram alterados. Resultados: Foram notificados 415 casos incidentes. Os Médicos Sentinela fizeram a prescrição inicial em 89,4% dos casos (IC 95% 86,0% - 92,0%). O tratamento inicial mais escolhido foi a metformina, em 85,5% dos doentes (IC 95% 81,8% - 88,6%). Os médicos de família utilizaram menos inibidores da dipeptidil peptidase-4 (4,2% vs 30,3%, p < 0,001) e insulina (0,3% vs 12,1%, p < 0,001) que outros especialistas. As prescrições iniciadas por outros foram alteradas em 4,5% dos casos (IC 95% 0,4% - 16,0%). Discussão: A colheita prospectiva dos dados é um ponto forte, mas foram notificados poucos casos de tratamento iniciado por outros especialistas. Dados sobre a gravidade da doença não estavam disponíveis e podem explicar parte das diferenças entre médicos de família e outros especialistas. Conclusão: A metformina foi o tratamento inicial mais escolhido, em linha com as recomendações das normas de orientação clínica Portuguesas. Os médicos da Rede Sentinela diagnosticaram a maioria dos casos, raramente alteraram prescrições iniciadas por outros e tiveram um padrão de prescrição diferente de outros especialistas.Ordem dos MédicosRepositório Científico do Instituto Nacional de SaúdePinto, DanielRodrigues, Ana PaulaNunes, Baltazar2020-08-03T13:57:28Z2019-052019-05-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.18/7180engActa Med Port 2019 May;32(5):375-380. doi:10.20344/amp.104141646-075810.20344/amp.10414info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-20T15:41:50Zoai:repositorio.insa.pt:10400.18/7180Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:41:50.153776Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network Escolhas Terapêuticas Iniciais para a Diabetes Tipo 2 na Rede de Médicos Sentinela |
title |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
spellingShingle |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network Pinto, Daniel Diabetes Mellitus Diabetes Mellitus, Type 2 Cross-Sectional Studies Dipeptidyl-Peptidase IV Inhibitors Disease Notification Family Practice Female Humans Hypoglycemic Agents Insulin Life Style Male Metformin Middle Aged Aged Practice Patterns, Physicians' Diabetes Mellitus Tiye 2/Drug Therapy Primary Health Care Sentinel Surveillance Portugal Diabetes Mellitus Tipe 2/tratamento Hipoglicemiantes Cuidados de Saúde Cuidados de Saúde Primários Vigilância de Evento Sentinela Médicos-sentinela |
title_short |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
title_full |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
title_fullStr |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
title_full_unstemmed |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
title_sort |
Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network |
author |
Pinto, Daniel |
author_facet |
Pinto, Daniel Rodrigues, Ana Paula Nunes, Baltazar |
author_role |
author |
author2 |
Rodrigues, Ana Paula Nunes, Baltazar |
author2_role |
author author |
dc.contributor.none.fl_str_mv |
Repositório Científico do Instituto Nacional de Saúde |
dc.contributor.author.fl_str_mv |
Pinto, Daniel Rodrigues, Ana Paula Nunes, Baltazar |
dc.subject.por.fl_str_mv |
Diabetes Mellitus Diabetes Mellitus, Type 2 Cross-Sectional Studies Dipeptidyl-Peptidase IV Inhibitors Disease Notification Family Practice Female Humans Hypoglycemic Agents Insulin Life Style Male Metformin Middle Aged Aged Practice Patterns, Physicians' Diabetes Mellitus Tiye 2/Drug Therapy Primary Health Care Sentinel Surveillance Portugal Diabetes Mellitus Tipe 2/tratamento Hipoglicemiantes Cuidados de Saúde Cuidados de Saúde Primários Vigilância de Evento Sentinela Médicos-sentinela |
topic |
Diabetes Mellitus Diabetes Mellitus, Type 2 Cross-Sectional Studies Dipeptidyl-Peptidase IV Inhibitors Disease Notification Family Practice Female Humans Hypoglycemic Agents Insulin Life Style Male Metformin Middle Aged Aged Practice Patterns, Physicians' Diabetes Mellitus Tiye 2/Drug Therapy Primary Health Care Sentinel Surveillance Portugal Diabetes Mellitus Tipe 2/tratamento Hipoglicemiantes Cuidados de Saúde Cuidados de Saúde Primários Vigilância de Evento Sentinela Médicos-sentinela |
description |
Introduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists. Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed. Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%). Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists. Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-05 2019-05-01T00:00:00Z 2020-08-03T13:57:28Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.18/7180 |
url |
http://hdl.handle.net/10400.18/7180 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Acta Med Port 2019 May;32(5):375-380. doi:10.20344/amp.10414 1646-0758 10.20344/amp.10414 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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