Do guidelines matter? A population-based study of diabetes drug use during 20 years

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Abstract
Objective - To analyse diabetes drug use in a defined population during 20 years in relation to recommendations in published guidelines. Design - From the Tierp Study Database, all medical records for diabetes patients at the primary health care centre in Tierp municipality and all prescriptions for diabetes drugs at the local pharmacies during the period 1975-1994 were collected. Data for 2125 persons were obtained, generating 13 190 person-years of observation. Setting - Tierp primary health care district. Main outcome measures - Diabetes treatment. Results - The annual prevalence of diabetes mellitus increased from 2.8% (565 patients) to 3.8% (734 patients). When guidelines emphasised diet treatment, treatment with diet only increased and oral pharmacological treatment decreased. When guidelines emphasised better glycaemic control, diet only decreased and biguanide treatment increased, and when guidelines emphasised vigorous glycaemic control, treatment with diet only decreased further and sulphonylurea and insulin use increased. The substantial age and sex differences in antidiabetic drug use at the beginning of the period were partly reduced over time. Conclusions ? The considerable changes in antidiabetic drug use during the study period coincided with changes in the guidelines issued. The age and sex differences in drug use became less pronounced towards the end of the period.

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