Use of Antidiabetic Drugs in the U.S., 2003–2012

TLDR

The study highlights a need to investigate why 33–48% of non‑insulin antidiabetic prescriptions are not combined with metformin, contrary to guidelines. The authors aim to chart market trends for antidiabetic drugs, emphasizing newly approved agents, patterns of concomitant use, and the impact of safety concerns and access restrictions on thiazolidinedione utilization. They analyzed nationally projected prescription data from IMS Health Vector One, Encuity Research Treatment Answers, and Symphony Health PHAST for 2003–2012 to quantify usage trends. Antidiabetic drug use rose 42.9% to 18.8 million adults by 2012, with metformin prescriptions doubling (97% increase to 60.4 million), sitagliptin becoming the most prescribed new agent (10.5 million), rosiglitazone falling below 13 000 prescriptions after 2011 restrictions, and 44.9% of metformin use being monotherapy while 33–48% of other non‑insulin agents were prescribed without metformin.

Abstract

To describe market trends for antidiabetic drugs, focusing on newly approved drugs, concomitant use of antidiabetic drugs, and effects of safety concerns and access restrictions on thiazolidinedione use.Nationally projected data on antidiabetic prescriptions for adults dispensed from U.S. retail pharmacies were extracted from IMS Health Vector One National and Total Patient Tracker for 2003-2012 and from Encuity Research Treatment Answers and Symphony Health Solutions PHAST Prescription Monthly for 2012.Since 2003, the number of adult antidiabetic drug users increased by 42.9% to 18.8 million in 2012. Metformin use increased by 97.0% to 60.4 million prescriptions dispensed in retail pharmacies in 2012. Among antidiabetic drugs newly approved for marketing between 2003 and 2012, the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin had the largest share with 10.5 million prescriptions in 2012. Rosiglitazone use plummeted to <13,000 prescriptions dispensed in retail or mail-order pharmacies in 2012. Concomitancy analyses showed that 44.9% of metformin use was for monotherapy. Between 33.4 and 48.1% of sulfonylurea, DPP-4 inhibitor, thiazolidinedione, and glucagon-like peptide 1 analog use was not accompanied by metformin.The antidiabetic drug market is characterized by steady increases in volume, and newly approved drugs experienced substantial uptake, especially DPP-4 inhibitors. The use of rosiglitazone has been negligible since restrictions were put in place in 2011. Further study is needed to understand why one-third to one-half of other noninsulin antidiabetic drug use was not concomitant with metformin use despite guidelines recommending that metformin be continued when other agents are added to treatment.