(123) Disparity in guideline-based antidiabetic drugs prescribing for type 2 diabetes patients in primary healthcare facilities across China, 2017-2019
Peking University Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, China (People's Republic)
Background: Deviations of actual treatments from evidence-based treatments could partly account for insufficient diabetes control in China. Important knowledge gaps exist regarding antidiabetic drugs utilization in primary healthcare facilities (PHFs) in China.
Objectives: To evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with type 2 diabetes at primary healthcare facilities in China.
Methods: We collected outpatient-visit prescriptions from health records database within 363 PHFs in 31 cities and three regions (eastern, central, and western; the eastern region consists relative developed cities, while the western region consists developing cities). We included prescriptions with type 2 diabetes diagnosis for analysis. Prescriptions for children (≤18 years of age) or prescriptions with other type of diabetes were excluded. We classified each antidiabetic medication pattern as guideline-recommended or non-guideline recommended, in accordance with current Chinese guidelines. We calculated the proportion of guideline-recommended patterns and the average monthly total cost for each pattern, overall and by region.
Results: Of 33,519 prescriptions with type 2 diabetes, most (73.9%) were guideline-recommended antidiabetic treatment. The proportion of guideline-recommended antidiabetic prescriptions differed by regions (eastern [75.9%]; central [87.4%]; western [59.5%]). Metformin monotherapy was the most commonly used guideline-recommended treatment in all three regions (eastern [28.0%]; central [20.1%]; western [24.3%]), followed by metformin combining insulin secretagogues (eastern [23.7%]; central [27.6%]; western [10.4%]). The most common non-guideline-recommended treatments were insulin monotherapy (eastern [16.5%]; central [5.2%]; western [25.8%]) and traditional Chinese antidiabetic medicines (eastern [5.6%]; central [5.7%]; western [11.1%]). The average monthly costs were lower for guideline-recommended versus non-guideline-recommended treatments in all regions (eastern [13.6±15.4 versus 28.1±22.0 USD]; central [9.8±10.9 versus 28.7±19.4 USD]; western [17.9±21.4 versus 30.3±23.6 USD]).
Conclusions: The majority of patients with type 2 diabetes received guideline-recommended antidiabetic medications in PHFs in China, with only half of the prescriptions containing guideline-recommended metformin. Utilization of guideline-recommended therapies differed across regions. Tailored interventions to promote evidence-based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.