Changes in Antidiabetic Drug Prescription and Glycemic Control Trends in Elderly Patients with Type 2 Diabetes Mellitus from 2005-2013: An Analysis of the National Center Diabetes Database (NCDD-03)

Ritsuko Yamamoto-Honda; Yoshihiko Takahashi; Yasumichi Mori; Shigeo Yamashita; Yoko Yoshida; Shoji Kawazu; Yasuhiko Iwamoto; Hiroshi Kajio; Hidekatsu Yanai; Shuichi Mishima; Nobuhiro Handa; Kotaro Shimokawa; Akiko Yoshida; Hiroki Watanabe; Kazuhiko Ohe; Takuro Shimbo; Mitsuhiko Noda

doi:10.2169/internalmedicine.9481-17

ORIGINAL ARTICLES

Changes in Antidiabetic Drug Prescription and Glycemic Control Trends in Elderly Patients with Type 2 Diabetes Mellitus from 2005-2013: An Analysis of the National Center Diabetes Database (NCDD-03)

Ritsuko Yamamoto-Honda, Yoshihiko Takahashi, Yasumichi Mori, Shigeo Yamashita, Yoko Yoshida, Shoji Kawazu, Yasuhiko Iwamoto, Hiroshi Kajio, Hidekatsu Yanai, Shuichi Mishima, Nobuhiro Handa, Kotaro Shimokawa, Akiko Yoshida, Hiroki Watanabe, Kazuhiko Ohe, Takuro Shimbo, Mitsuhiko Noda

Author information

Ritsuko Yamamoto-Honda
Department of Diabetes Research and Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Japan
Health Management Center, Toranomon Hospital, Japan
Department of Endocrinology and Metabolism, Toranomon Hospital, Japan
Yoshihiko Takahashi
Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Center Hospital, Japan
Division of Diabetes and Metabolism, Iwate Medical University, Japan
Yasumichi Mori
Department of Endocrinology and Metabolism, Toranomon Hospital, Japan
Shigeo Yamashita
Department of Diabetes and Endocrinology, JR Tokyo General Hospital, Japan
Division of Diabetes and Endocrinology, Department of Internal Medicine, Tokyo Yamate Medical Center, Japan Community Health Care Organization, Japan
Yoko Yoshida
Department of Diabetes, the Institute for Adult Diseases, Asahi Life Foundation, Japan
Shoji Kawazu
Department of Diabetes, the Institute for Adult Diseases, Asahi Life Foundation, Japan
Yasuhiko Iwamoto
Department of Diabetes, the Institute for Adult Diseases, Asahi Life Foundation, Japan
Hiroshi Kajio
Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Center Hospital, Japan
Hidekatsu Yanai
Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Japan
Shuichi Mishima
Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Japan
Nobuhiro Handa
Nagara Medical Center, National Hospital Organization, Japan
Kotaro Shimokawa
Yutenji Medical Clinic, Japan
Akiko Yoshida
Kanamachi Yoshida Clinic, Japan
Hiroki Watanabe
National Hospital Organization, Japan
Kazuhiko Ohe
Department of Medical Informatics and Economics, Graduate School of Medicine, The University of Tokyo, Japan
Takuro Shimbo
Ohta Nishinouchi Hospital, Japan
Mitsuhiko Noda
Department of Diabetes Research and Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Japan
Department of Endocrinology and Diabetes, Saitama Medical University, Japan

Keywords: antidiabetic drugs, elderly, type 2 diabetes

JOURNAL OPEN ACCESS
Supplementary material

2018 Volume 57 Issue 9 Pages 1229-1240

DOI https://doi.org/10.2169/internalmedicine.9481-17

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Abstract

Objective To analyze the changes in the pharmacotherapy and glycemic control trends in elderly patients with type 2 diabetes mellitus (T2DM) in Japan.

Methods We extracted the data of 7,590 patients (5,396 men and 2,194 women; median year of birth: 1945) with T2DM registered in the National Center Diabetes Database for the years 2005 to 2013, and conducted age-stratified (<65, 65-74, and ≥75 years of age) analyses.

Results The hemoglobin A1c (HbA1c) levels declined from 2005 to 2013, and for those who received antihyperglycemic drug prescription, the HbA1c levels were lower in the older age group than in the younger age group. In the ≥75 age group, dipeptidyl peptidase-4 inhibitors (DPP4i) became the most frequently prescribed drug (49.1%) in 2013, and sulfonylureas remained the second-most frequently prescribed drug (37.8%) with decreased prescribed doses. The prescription ratio of oral drugs associated with a risk of hypoglycemia was higher in patients ≥75 years of age than in those <75 years of age (40.5% and 26.4%, respectively in 2013), although it showed a downward trend. The prescription rates of insulin for patients ≥75 years of age increased during the study period.

Conclusion The pharmacotherapy trends for elderly patients with T2DM changed dramatically in Japan with the launch of DPP4i in 2009. Glycemic control in a considerable portion of the ≥75 age group in Japan was maintained at the expense of potential hypoglycemia by the frequent, although cautious, use of sulfonylureas, glinides and insulin.

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