Currently, 25 million Americans are known to have diabetes, with an additional 7 million cases believed to be undiagnosed. It is estimated that direct and indirect costs of diabetes top $200 billion. Due to the significant health and financial burdens associated with diabetes, it is imperative that this disease be treated quickly and aggressively. In 2009, the American Diabetes Association and the European Association for the Study of Diabetes developed a consensus statement regarding the treatment of type 2 diabetes, citing lifestyle modification and metformin as the preferred first line therapies. In this study, the authors looked at prescription claims data for adults who were newly initiated on oral hypoglycemic monotherapy between January 1, 2006, and December 31, 2008, to determine if initiation patterns changed over time, to evaluate how well the treatment guidelines were being followed, and to assess the economic consequences of prescribing patterns by drug class for both patients and insurers. The results showed that over the course of the study period the proportion of patients initially treated with metformin increased, whereas those receiving sulfonylureas as first-line therapy decreased. Thiazolidinediones experienced the greatest decrease, falling from 20% to 8%, while prescriptions for dipeptidyl peptidase-4 inhibitors increase from 0-7%. Over a 6-month period, patients taking metformin or sulfonylureas paid approximately $38 to $40 in co-pays while insurance paid about $77. Patients taking other agents paid approximately $130 in co-pays and insurance paid over $500. The authors concluded that based its cost and safety profile, metformin should be the first line drug therapy for patients with newly diagnosed type 2 diabetes. This CME multimedia activity, which is part of a 2-part multimedia activity on the management and treatment of diabetes, contains a video presentation and is available through the website of The American Journal of Medicine at http://amjmed.com/content/multimedia. Click on "Patterns of Medication Initiation in Newly Diagnosed Diabetes Mellitus: Quality and Cost Implications" to access this part of the multimedia program.

译文

目前,已知有2500万名美国人患有糖尿病,另外700万例病例被认为无法诊断。据估计,糖尿病的直接和间接成本高达2000亿美元。由于与糖尿病相关的重大健康和经济负担,必须迅速积极地治疗这种疾病。2009年,美国糖尿病协会和欧洲糖尿病研究协会提出了关于2型糖尿病治疗的共识声明,理由是生活方式改变和二甲双胍是首选的一线疗法。在这项研究中,作者查看了2006年1月1日和2008年12月31日之间新开始口服降糖单药治疗的成年人的处方索赔数据,以确定起始模式是否随时间变化,以评估治疗指南的遵循程度。并按药物类别评估处方模式对患者和保险公司的经济后果。结果显示,在研究期间,最初接受二甲双胍治疗的患者比例增加,而接受磺脲类药物作为一线治疗的患者比例下降。噻唑烷二酮类药物的下降幅度最大,从20% 降至8%,而二肽基peptidase-4抑制剂的处方从0-7% 增加。在6个月的时间里,服用二甲双胍或磺脲类药物的患者支付了大约38至40美元的共付额,而保险支付了大约77美元。接受其他代理的患者支付了大约130美元的自付费用,保险支付了超过500美元。作者得出结论,基于其成本和安全性,二甲双胍应该是新诊断的2型糖尿病患者的一线药物治疗。此CME多媒体活动是有关糖尿病管理和治疗的两部分多媒体活动的一部分,包含视频演示,可通过http://amjmed.com/content/multimedia. 的《美国医学杂志》网站获得点击 “新诊断糖尿病开始用药的模式: 质量和成本影响”,访问多媒体程序的这一部分。

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