Diabetes is considered to be one of the most common non-communicable and incurable chronic diseases.
The aim of our study is to evaluate the patterns of prescribing of medicines used in diabetes in Slovenia, to determine the incidence of type 2 diabetes and to evaluate the course of treatment of Slovenian patients with type 2 diabetes and the factors that influence the change in therapy of these patients.
The pharmacoepidemiological study was performed on the basis of an anonymized database of all prescribed medicines obtained from the Health Insurance Institute of Slovenia. We focused on the prescription of antidiabetic medicines in period from 2008 to 2018.
Trend of prescribing medicines for the treatment of diabetes was increasing, as between 2008 and 2018, the number of prescriptions increased from 443.167 to 661.221, that is 49,2 %. Metformin was the most frequently prescribed medicine. Newer medicines for type 2 diabetes, that is dipeptidyl peptidase 4 inhibitors, glucagon-like peptide-1 analogues and sodium/glucose cotransporter 2 inhibitors, are poorly prescribed in Slovenia.
During the years 2008 to 2018 the number of patients taking antidiabetic medicines in Slovenia increased from 83,303 to 111,504, that is 33.9%. The proportion of men and the average age of patients increased. According to statistical regions, the highest proportion of people receiving antidiabetic medicines is in the pomurska, savinjska and posavska regions.
The incidence of type 2 diabetes in Slovenia is declining; in 2018, there were 1.628 new patients less than in 2009. The incidence is higher for men than for women.
Newly treated type 2 diabetes patients mostly received monotherapy with metformin. The proportion of patients who started treatment with sulphonylureas in monotherapy decreased from 24% in 2008 to about 7% in 2018. Further research only included patients who started treatment in 2014 on monotherapy with metformin or monotherapy with sulphonylurea. In the second line of treatment, patients starting therapy with metformin monotherapy are mostly prescribed sulphonylureas. In the second line of treatment of patients starting therapy with sulfonylurea in monotherapy are most commonly prescribed metformin.
Using Kaplan-Meier survival analysis we found that patients who started treatment with sulfonylurea in monotherapy were more likely to change therapy, than patients who started therapy with metformin in monotherapy. The likelihood of a therapy change is higher in younger age groups (under 65 years). Compared to the pomurje region, they are most likely to change therapy in the zasavska and obalno-kraška regions. Patients who receive antihypertensive and nonsteroidal anti-inflammatory drugs in addition to antidiabetic medicines are more likely to change therapy.
The results of the master's thesis provide up-to-date information on the prevalence, incidence and course of pharmacotherapy of type 2 diabetes in Slovenia and can contribute to a better understanding of the extent of disease burden.