Article Figures & Data
Figures
- Figure 1.
Changes in use of non-antiglycemic drugs (A) and changes in use of antiglycemic drugs (B).
AGI = α-glucosidase inhibitor; ACE = angiotensin converting enzyme; ARB = angiotensin receptor blocker; DPP-4i = dipeptidyl peptidase-4 inhibitor.
Tables
Outcome Measured Mean for Each Year Change from 2016 to 2017 No. (%) Change from 2016 to 2018 No. (%) Mean for 2016-2018 2016 2017 2018 Number of medications 3.64 3.83 3.63 3.48 -0.20 (-5.2) -0.34 (-9.0) Antiglycemic drugs 1.57 1.61 1.56 1.55 -0.05 (-3.35) -0.06 (-3.6) Non-antiglycemic drugs 2.07 2.22 2.07 1.93 -0.15 (-7.0) -0.29 (-12.9) Number of comorbidities 4.74 4.74 4.80 4.69 0.06 (1.2) -0.05 (-1.1) Glycemic diseases 1.25 1.26 1.25 1.25 -0.01 (-0.6) -0.01 (-0.8) Non-glycemic diseases 3.49 3.49 3.55 3.45 0.06 (1.8) -0.04 (-1.2) Total annual drug cost, ¥ 6,033 6,868 5,701 5,605 -1,167 (-17.0) -1,263 (-18.4) Antiglycemic drugs 3,387 3,729 3,221 3,240 -508 (-13.6) -489 (-13.1) Non-antiglycemic drugs 2,646 3,139 2,480 2,365 -659 (-21.0) -774 (-24.7) Total annual cost/drug, ¥ 1,591 1,718 1,511 1,553 -207 (-12.1) -165 (-9.6) Cost/antiglycemic drug/) 2,046 2,192 1,968 1,986 -224 (-10.2) -207 (-9.4) Cost/non-antiglycemic drug 1,191 1,314 1,117 1,148 -198 (-15.0) -166 (-12.6) Patient Group Parameter No. of Patients Mean SD Adjusted Mean Difference Compared With Reference Age, y ≥85 No. of medications 74,064 3.74 2.33 3.80 Ref Cost, ¥ 71,917 6,007 4,777 6,333 Ref 15-44 No. of medications 234,195 2.66 2.05 3.71 -0.09 Cost, ¥ 210,571 4,660 4164 7,605 1,272 45-64 No. of medications 1,490,660 3.62 2.31 3.90 0.12 Cost, ¥ 1,431,655 6,041 4,904 7,155 822 65-84 No. of medications 1,054,117 3.88 2.39 3.89 0.09 Cost, ¥ 1,023,208 6,307 4973 6,732 398 Sex Male No. of medications 1,464,378 3.70 2.34 3.95 Ref Cost, ¥ 1,415,413 6,069 4,888 7,327 Ref Female No. of medications 1,388,658 3.57 2.34 3.71 -0.24 Cost, ¥ 1,321,938 5,995 4895 6,630 -697 Hypertension Absent No. of medications 1,096,600 2.10 1.54 2.90 Ref Present 1,756,436 4.60 2.24 5.04 2.14 Absent Cost, ¥) 1,003,635 3,866 3,417 4,034 Ref Present 1,733,716 7,288 5,170 8,226 4,192 Coronary heart disease Absent No. of medications 1,442,472 2.62 1.86 3.36 Ref Present 1,410,564 4.68 2.32 4.36 1.00 Absent Cost, ¥ 1,345,084 4,413 3,778 5,330 Ref Present 1,392,267 7,599 5,319 8,045 2,715 Dyslipidemia Absent No. of medications 1,524,133 2.61 1.83 3.22 Ref Present 1,328,903 4.82 2.31 4.55 1.32 Absent Cost, ¥ 1,427,259 4,382 3,714 4,961 Ref Present 1,310,092 7,833 5,363 8,548 3,588 Stroke Absent No. of medications 2,248,774 3.40 2.26 3.71 Ref Present 604,262 4.53 2.40 3.95 0.24 Absent Cost, ¥ 2,143,127 5,612 4,630 6,805 Ref Present 594,224 7,554 5,475 7,455 650 Chronic lung disease Absent No. of medications 2,324,751 3.52 2.31 3.71 Ref Present 528,285 4.15 2.40 3.95 0.24 Absent Cost, ¥ 2,217,914 5,838 4,791 6,743 Ref Present 519,437 6,870 5,220 7,888 1,145 Osteoporosis Absent No. of medications 2,446,815 3.53 2.31 3.72 Ref Present 406,221 4.33 2.37 3.94 0.23 Absent Cost, ¥ 2,336,977 5,806 4,765 6,748 Ref Present 400,374 7,362 5,386 8,117 1,369 Diabetic peripheral neuropathy Absent No. of medications 2,477,820 3.51 2.29 3.69 Ref Present 375,216 4.47 2.48 3.97 0.28 Absent Cost, ¥ 2,370,132 5,801 4,755 6,818 Ref Present 367,219 7,530 5,464 7,821 1,003 Diabetic nephropathy Absent No. of medications 2,732,287 3.60 2.32 3.68 Ref Present 120,749 4.56 2.59 3.98 0.3 Absent Cost, ¥ 2,619,298 5,939 4,817 6,924 Ref Present 118,053 8,122 5,951 8,034 1,110 Diabetic neuropathy Absent No. of medications 2,726,009 3.58 2.31 3.55 Ref Present 127,027 4.84 2.59 4.13 0.57 Absent Cost, ¥ 2,612,704 5,931 4,825 6,866 Ref Present 124,647 8,185 5,714 8,986 2,120 No. of comorbidities 0 No. of medications 488,070 1.44 1.10 1.71 Ref Cost, ¥ 421,666 2,889 2,698 2,358 Ref 1 No. of medications 556,656 2.56 1.54 3.04 1.33 Cost, ¥ 530,638 4,132 3,346 3,564 1,205 2 No. of medications 623,184 3.58 1.86 4.24 2.53 Cost, ¥ 609,140 5,561 4,055 5,384 3,026 3 No. of medications 665,476 4.75 2.18 5.61 3.89 Cost, ¥ 658,609 7,526 5,025 8,136 5,777 4 No. of medications 380,887 5.37 2.24 6.30 4.59 Cost, ¥ 378,936 8,861 5,540 12,293 9,935 5 No. of medications 120,907 5.85 2.34 6.80 5.09 Cost, ¥ 120,551 9,990 6,002 18,575 16,216 6 No. of medications 17,856 6.30 2.49 7.24 5.53 Cost, ¥ 17,811 11,143 6,689 28,066 25,708 No. of complications 0 No. of medications 2,283,312 3.44 2.25 3.17 Ref Cost, ¥ 2,180,877 5,659 4,653 6,576 Ref 1 No. of medications 447,025 4.22 2.45 3.48 0.32 Cost, ¥ 434,647 7,096 5,311 7,877 1,302 2 No. of medications 104,086 5.07 2.51 3.96 0.79 Cost, ¥ 103,240 8,720 5,780 9,436 2,861 3 No. of medications 17,298 5.73 2.51 4.24 1.07 Cost, ¥ 17,273 10,069 6,143 11,304 4,728 Ref = reference.
Note: Adjusted variables include age, sex, hypertension, coronary heart disease, dyslipidemia, stroke, chronic lung disease, osteoporosis, diabetic peripheral neuropathy, diabetic nephropathy, diabetic neuropathy, comorbidity, complication and a variable for the sampling time frame (2016, 2017, and 2018). Values of all regression coefficients above were significant at P <.001.
Type of Insulin Used 2016 (%) 2017 (%) 2018 (%) χ2 Valuea Fast-acting No 91.8 89.2 87.1 Yes 8.2 10.8 12.9 2,790.6 Short-acting No 87.2 88.3 89.2 Yes 12.8 11.7 10.8 480.1 Intermediate-acting No 84.7 86.0 87.2 Yes 15.3 14.0 12.8 597.8 Long-acting No 79.2 74.8 70.0 Yes 20.8 25.2 30.0 5,226.4 Premixed No 39.5 43.3 48.0 Yes 60.5 56.7 52.0 3,453.6 ↵a All values significant at P <.001.
Supplemental Tables 1-5
- 332_supp.pdf -
PDF file
- 332_supp.pdf -
The Article in Brief
Lixin Guo , and colleagues
Background Approximately 642 million people are expected to be diagnosed with diabetes by 2040, with Asians representing more than 55% of cases. Researchers conducted the first large-scale study since the implementation of medical insurance in China to evaluate the complexity and cost of drug therapy for Asian people with diabetes. They used available treatment records from Beijing’s medical insurance bureau from 2016 to 2018 and looked at five outcomes, including: 1) quantity of outpatient medications, 2) number of co-morbidities diagnosed, 3) estimated annual cost of the outpatient drug regimen, 4) drug therapy strategies for diabetic patients and 5) the most commonly prescribed drug class in the patient cohort.
What This Study Found Over three years, there was a gradual decrease of almost 9% decrease in the average quantity of diabetes medications. The mean usage of both anti-glycemic and non-antiglycemic drugs decreased by 3.6% and 12.8%, respectively. Researchers found an 18.39% decrease in estimated annual medication costs. The decrease in medical costs could be due to rational use of medications, leading to a decrease in the usage of medications over the three years. This is especially true for what the authors call the needless use of most types of insulin. This could have indirectly led to decreased costs.
Implications
- Therapeutic drugs should be selected with caution according to the diet and lifestyle of each individual.
