Toenemend gebruik van geneesmiddelen voor diabetes mellitus in Nederland, 1998-2003

To describe trends in the use of diabetes treatment from 1998-2003 and to compare prescribing in daily practice with the practice guideline 'Diabetes mellitus type 2' issued by the Dutch College of General Practitioners. Descriptive. Prescribing data over the period 1998-2003 were taken from the database of the Drug Information Project of the Dutch Health Care Insurance Board. The database contains information on drugs prescribed extramurally and dispensed either by pharmacists or dispensing general practitioners, and reimbursed by health insurance funds. The data are aggregated into volume and cost variables for the general population and individual users were identified to monitor individual use of the medication and co-medication over a period of time. From 1998-2003 the use of medication for treating diabetes in the Netherlands increased from 2.8% to 3.6%. There were 565,000 users of diabetes medication in 2003. The rate of prescription of oral blood-glucose lowering drugs increased more than that for insulin. The rate of concurrent use of an oral drug as well as insulin rose sharply as did the use of more than one type of oral drugs and the use of co-medication, notably cholesterol reducers. With respect to the guidelines, nearly all newly diagnosed type-2 diabetics were initially prescribed metformin or a sulfonamid-urea derivative. In one-third of new patients, a second drug was also prescribed, the combination most used was metformin or a sulfonamid-urea derivative. Combinations of three or more drugs were rarely prescribed. The total cost of diabetes treatment increased from euros 122 million to euros 183 million. The increased use of thiazolidinediones played an important role in this increase. The use of oral blood-glucose lowering drugs and thiazolidinediones specifically, increased rapidly between 1998-2003. Individual treatment became more intensive, due to increased use of co-medication, combination therapy and the combined use of insulin and oral drugs. The compliance rate with the general practitioners' practice guidelines was high