Metabolic Control in Diabetic Subjects in Three Swedish Areas With High, Medium, and Low Sales of Antidiabetic Drugs

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Abstract
Objective The relationship between use of antidiabetic drugs and metabolic control was studied in Swedish diabetic populations in areas with high (Gotland), medium (Tierp), and low (Skellefteå) sales of antidiabetic drugs. Research Design and Methods The study population consisted of 405 drug-treated diabetic subjects aged 50–74 yr. In all three areas, glyburide comprised ∼75% of the oral treatment. Results In accordance with sales, Gotland was found to be a heavy-use area, characterized by a high prevalence of insulin treatment (43%), combination therapy with sulfonylureas and biguanide (28%), and high prescribed daily doses (PDDs) of glyburide (15.5 ± 0.8 mg) compared with other areas. In Skellefteå, 38% were on insulin, 4% were on combination therapy, and the PDD of glyburide was 7.1 ± 0.6 mg. In Tierp, 27% were on insulin, 26% were on combination therapy, and the PDD of glyburide was 11.4 ± 0.7 mg. In Gotland, both men and women had significantly lower HbA1c levels, regardless of treatment mode, and a tendency to be more overweight compared with the area with the least pharmacological intensity (Skellefteå). Conclusions In the three diabetic populations, good metabolic control, defined as an HbA1c level of < 7% and acceptable weight control (body mass index < 27 for men and < 25 for women), was achieved among only 16% in Gotland, 17% in Skellefteå, and 12% in Tierp.

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