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Rational Pharmacotherapy in Type 2 Diabetes: Danish Data From 2002 to 2020 on Mortality, Diabetes- Related Outcomes, Adverse Events, and Medication Expenses
Diabetes Care ( IF 14.8 ) Pub Date : 2024-07-12 , DOI: 10.2337/dc24-0619
Karl Sebastian Johansson 1 , Espen Jimenez-Solem 1, 2, 3 , Tonny Studsgaard Petersen 1, 2 , Mikkel Bring Christensen 1, 2, 4, 5
Affiliation  

OBJECTIVE Developments in pharmacotherapy and management of type 2 diabetes may have shifted the balance of treatment benefits versus harms and costs over the past decades. This study aimed to describe the trends in this balance. RESEARCH DESIGN AND METHODS We followed the Danish population with type 2 diabetes between 2002 and 2020, analyzing their medication use in relation to treatment benefits (such as mortality and diabetes-related outcomes), adverse events, and medication costs. Using multivariate analyses, we adjusted for potential confounders, including age, sex, and socioeconomic status. RESULTS The study included 461,805 individuals. From 2002 to 2020, the median age increased from 66 to 68 years, and the mean number of comorbidities increased from 5.2 to 8.8. The overall incidence of cardiovascular, renal, and other important adverse clinical outcomes decreased. Similarly, the rate of some adverse events, such as gastric bleeding, hypoglycemia, and falls declined, whereas the incidence of electrolyte imbalances and ketoacidosis increased. The average per-patient cost was reduced by 8%, but total medication expenses increased by 148% due to an expanding population size, lowered costs of most cardiovascular medications, and increasing costs for glucose-lowering drugs. CONCLUSIONS Advancements in type 2 diabetes management have led to reduced risk of both diabetes-related outcomes and treatment harms, while maintaining relatively stable per-patient medication expenses. Although these trends are multifactorial, they suggest more rational pharmacotherapy. Still, increased risk of certain adverse events, along with increasing costs for glucose-lowering medications, underscores the need for ongoing vigilance and risk-benefit analysis.

中文翻译:


2 型糖尿病的合理药物治疗:2002 年至 2020 年丹麦关于死亡率、糖尿病相关结果、不良事件和药物费用的数据



目标 过去几十年来,2 型糖尿病药物治疗和管理的发展可能改变了治疗益处与危害和成本的平衡。本研究旨在描述这种平衡的趋势。研究设计和方法 我们跟踪了 2002 年至 2020 年间丹麦 2 型糖尿病患者的情况,分析了他们的药物使用情况与治疗益处(例如死亡率和糖尿病相关结果)、不良事件和药物费用的关系。通过多变量分析,我们调整了潜在的混杂因素,包括年龄、性别和社会经济地位。结果 该研究包括 461,805 人。从2002年到2020年,中位年龄从66岁增加到68岁,平均合并症数量从5.2增加到8.8。心血管、肾脏和其他重要不良临床结局的总体发生率下降。同样,胃出血、低血糖和跌倒等一些不良事件的发生率有所下降,而电解质失衡和酮症酸中毒的发生率则有所增加。每名患者的平均费用降低了 8%,但由于人口规模的扩大、大多数心血管药物的成本降低以及降糖药物的成本增加,总药物费用增加了 148%。结论 2 型糖尿病管理的进步降低了糖尿病相关结局和治疗危害的风险,同时保持了相对稳定的每位患者药物费用。尽管这些趋势是多因素的,但它们表明更合理的药物治疗。尽管如此,某些不良事件的风险增加,以及降糖药物成本的增加,凸显了持续保持警惕和风险效益分析的必要性。
更新日期:2024-07-12
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