Article Text
Abstract
Objective To evaluate oral anticoagulant (OAC) prescribing trends in type 2 diabetes mellitus (T2DM) in the UK from 2001 to 2015.
Design A cross-sectional drug utilisation study.
Setting Electronic health records from The Health Improvement Network primary care database in the UK.
Participants Individuals with T2DM who received a record of OAC prescription.
Outcome measures The prescribing trends of OAC medications in individuals with T2DM were examined from 2001 to 2015, stratified by age, gender and therapeutic classifications.
Results A total of 361 635 individuals with T2DM were identified, of whom 36 570 were prescribed OAC from 2001 to 2015. The prevalence of OAC prescribing increased by 50.0%, from 1781 individuals receiving OAC prescriptions (IROACP) (4.4 (95% CI 4.2 to 4.6) per 100 persons) in 2001, to 17 070 IROACP (6.6 (95% CI 6.5 to 6.7) per 100 persons) in 2015. The prevalence of warfarin prescribing decreased by 14.0%, from 1761 individuals receiving warfarin prescriptions (IRWP) (98.9 (95% CI 98.4 to 99.4) per 100 persons) in 2001, to 14 533 IRWP (85.1 (95% CI 84.6 to 85.7) per 100 persons) in 2015. This corresponded with increased prescribing of direct oral anticoagulants (DOACs), from 18 individuals receiving DOAC prescriptions (IRDOACP) (0.1 (95% CI 0.08 to 0.23) per 100 persons) in 2010, to 3016 IRDOACP (17.6 (95% CI 17.1 to 18.2) per 100 persons) in 2015, during the same period.
Conclusions Prescribing of OACs in individuals with T2DM increased from 2001 to 2015. Since the introduction of DOACs, there has been a clear shift in prescribing towards these agents. Future studies are needed to assess the safety of coadministration of OAC medications and antidiabetic therapy with T2DM.
- epidemiology
- diabetes & endocrinology
- anticoagulation
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Footnotes
Twitter @KennethKCMan
Contributors HA, LW and ICKW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HA, LW and ICKW contributed to the study design. HA, LW, KKCM and PM contributed to the statistical analysis. HA, LW and ICKW were involved in the interpretation of data. HA wrote the first draft of the article. HA, LW, AYN, JSB, JI, GT, GF and ICKW made substantial contributions to the drafts, reviewed the manuscript for important intellectual content and provided final approval of the version to be published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding JSB, LW, ICKW, GF and JI received PharmAlliance project grant to conduct collaborative research between UCL, Monash and UNC. HA's PhD project was supported by a scholarship from the Saudi Arabian Ministry of Higher Education.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The present study is based on anonymised and unidentifiable THIN data; thus, the need for informed consent was waived by the THIN scientific review committee (SRC). This study was reviewed and scientific approval was obtained by THIN SRC in 2018 (18THIN009).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.