Prescription drug use among diabetics--a population study

Diabetes and obesity in Northern Sweden: occurrence and risk factors for stroke and myocardial infarction

Aims: The authors describe the occurrence of diabetes and obesity in the population of Northern Sweden and the role of diabetes in cardiovascular disease. Methods: Four surveys of the population aged 25 to 64 years were undertaken during a 14-year time span. Stroke events in subjects 35 - 74 years during 1985 - 92 and myocardial infarction in subjects 25 - 64 years 1989 - 93 were registered. Results: The prevalence of diagnosed diabetes was 3.1 and 2.0% in men and women, respectively, and 2.6 and 2.7% for previously undiagnosed diabetes. During the 13-year observation period, BMI increased 0.96 kg/m2 in men and 0.87 in women. The proportion of subjects with obesity (BMI≥30) increased from 10.3% to 14.6% in men and from 12.5% to 15.7% in women. Hip circumference increased substantially more than waist circumference, leading to a decreasing waits-to-hip ratio (WHR). The relative risk for stroke or myocardial infarction was four to six times higher in a person with diabetes than in those without diabetes. The 28-day case fatality for myocardial infarction, but not for stroke, was significantly higher in both men and women with diabetes. Population-attributable risk for diabetes and stroke was 18% in men and 22% in women and for myocardial infarction it was 11% in men and 17% in women. Conclusion: Obesity is becoming more common, although of a more distal than central distribution. The burden of diabetes in cardiovascular diseases in Northern Sweden is high.

Effect of diabetes mellitus on pharmacokinetic and pharmacodynamic properties of drugs

The effects of diabetes mellitus on the pharmacokinetics and pharmacodynamics of drugs have been well described in experimental animal models; however, only minimal data exist for humans and the current knowledge regarding the effects of diabetes on these properties remains unclear. Nevertheless, it has been observed that the pharmacokinetics and pharmacodynamics of drugs are changed in subjects with diabetes. It has been reported that diabetes may affect the pharmacokinetics of various drugs by affecting (i) absorption, due to changes in subcutaneous adipose blood flow, muscle blood flow and gastric emptying; (ii) distribution, due to non-enzymatic glycation of albumin; (iii) biotransformation, due to regulation of enzymes/transporters involved in drug biotransformation; and (iv) excretion, due to nephropathy. Previously published data also suggest that diabetes-mediated changes in the pharmacokinetics of a particular drug cannot be translated to others. Although clinical studies exploring the effect of diabetes on pharmacodynamics are still very limited, there is evidence that disease-mediated effects are not limited only to pharmacokinetics but also alter pharmacodynamics. However, for many drugs it remains unclear whether these influences reflect diabetes-mediated changes in pharmacokinetics rather than pharmacodynamics. In addition, even though diabetes-mediated pharmacokinetics and pharmacodynamics might be anticipated, it is important to study the effect on each drug and not generalize from observed data. The available data indicate that there is a significant variability in drug response in diabetic subjects. The discrepancies between individual clinical studies as well as between ex vivo and clinical studies are probably due to (i) the restricted and focused population of subjects in clinical studies; (ii) failure to consider type, severity and duration of the disease; (iii) histopathological characteristics generally being missing; and (iv) other factors such as varying medication use, dietary protein intake, age, sex and obesity. The obesity epidemic in the developed world has also inadvertently influenced the directions of pharmacological research. This review attempts to map new information gained since Gwilt published his paper in Clinical Pharmacokinetics in 1991. Although a large body of research has been conducted and significant progress has been made, we still have to conclude that the available information regarding the effect of diabetes on pharmacokinetics and pharmacodynamics remains unclear and further clinical studies are required before we can understand the clinical significance of the effect. An understanding of diabetes-mediated changes as well as of the source of the variability should lead to the improvement of the medical management and clinical outcomes in patients with this widespread disease.

Influence of overt diabetes mellitus on cyclosporine pharmacokinetics in a canine model

Background/Aims. Diabetic patients usually require more medications than their nondiabetic counterparts. This work examined the effect of hyperglycemia on the pharmacokinetic properties of cyclosporine in a diabetic dog model. Main Methods. Diabetes was induced using a streptozotocin/alloxan combination and verified by measuring the serum glucose level. Cyclosporine was administered as a bolus intravenous dose of 5 mg/kg, and blood samples were collected at different time points for determining drug concentrations and biochemical analyses. Results. Diabetic dogs showed a significant increase in total body clearance of cyclosporine compared to healthy controls (0.457 L hr⁻¹Kg⁻¹ versus 0.201 L hr⁻¹Kg⁻¹, P = .0019) and a decrease in its biological half-life (9.32 hours versus 22.56 hours, P = .0125). In addition, diabetic animals exhibited a higher total cholesterol (7.20 ± 0.62 mmol/L and 5.28 ± 0.36 mmol/L; P < .05) as well as more serum low density lipoproteins (4.45 ± 0.72 mmol/L versus 1.06 ± 0.10 mmol/L; P < .05). Conclusion. Overt diabetes alters cyclosporine disposition by modulating its clearance. Abnormalities in the lipid profile, among other factors, may contribute to the accelerated metabolic degradation of cyclosporine under hyperglycemic conditions.

Constitutive androstane receptor mediates the induction of drug metabolism in mouse models of type 1 diabetes

Untreated type 1 diabetes increases hepatic drug metabolism in both human patients and rodent models. We used knockout mice to test the role of the nuclear xenobiotic receptors constitutive androstane receptor (CAR) and pregnane and xenobiotic receptor (PXR) in this process. Streptozotocin-induced diabetes resulted in increased expression of drug metabolizing cytochrome P450s and also increased the clearance of the cytochrome P450 substrate zoxazolamine. This induction was completely absent in Car(-/-) mice, but was not affected by the loss of PXR. Among the many effects of diabetes on the liver, we identified bile acid elevation and activated adenosine monophosphate-activated protein kinase as potential CAR-activating stimuli. Expression of the CAR coactivator peroxisome proliferator-activated receptor gamma coactivator (PGC)-1alpha was also increased in mouse models of type 1 diabetes.

CONCLUSION

The CAR-dependent induction of drug metabolism in newly diagnosed or poorly managed type 1 diabetes has the potential for significant impact on the efficacy or toxicity of therapeutic agents.

Approaches to assessing the rationality of drug usage in a developed country

The prerequisites for analyses of the medical, social and economic consequences of drug usage are in part available in Sweden. Hard data, though, are still fragmentary. Examples are given where various data sources and methods have been applied. It is suggested that feedback of drug utilization data should increase to create a more questioning attitude among prescribers. The concept of medical audit has to be better explained including the fact that individual-based registers are necessary tools in trying to assess the rationality of drug treatment. In the future such analyses should focus on everyday treatment of common disease entities such as hypertension, diabetes, dyspepsia and asthma. Long term medical and economical consequences of optimized pharmacological versus non-pharmacological treatment should be studied.

Daytime sleepiness, diabetes, and psychological well-being

Nominal group technique was used with persons with type 2 diabetes to identify and rank the severity of problems associated with being sleepy. Participants were adults who were subjectively sleepy according to the Epworth Sleepiness Scale. Daytime sleepiness was associated with a general decrease in motivation to engage in activities that are important to the management of diabetes. Because decreased motivation may have a negative influence on psychological well-being, it is important that health care providers assess not only for how well their patients' diabetes is being controlled, but also for sleep disturbances and the patients' general state of psychological well-being.

The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months

PURPOSE

To describe the content and potentials of the new Swedish national register on prescribed and dispensed medicines.

METHODS

The Swedish Prescribed Drug Register contains information about age, sex and unique identifier of the patient as well as the prescriber's profession and practice. Information regarding drug utilization and expenditures for prescribed drugs in the entire Swedish population was extracted from the first six months July-December 2005 and compared with total drug sales in the country including OTC and hospital use.

RESULTS

The total quantity of drugs sold in Sweden was 2666 million DDDs, corresponding to 1608 DDD/1000 inhabitants daily. The total expenditures were 1.6 billion Euro. The prescribed drugs, included in the register, accounted for 84% of the total utilization and 77% of the total expenditures. About half of all men and two-thirds of all women in the country purchased drugs. The proportion increased by age. The most common drugs for chronic treatment were diuretics among women (8.8% of the population) and antithrombotic agents among men (7.6%). Psychotropic drugs, corticosteroids and analgesics were more common among women, while men used antithrombotic agents, antidiabetic drugs, lipid lowering agents and ACE inhibitors to a greater extent.

CONCLUSIONS

The new register provides valuable data on exposure to drugs and is useful to study patterns of drug utilization. The possibilities for record linkage to other health registers gives from an international perspective good opportunities to explore drug and disease associations and the risks, benefits, effectiveness and health economical effects of drug use.

Diabetes and elimination of antipyrine in man: an analysis of 298 patients classified by type of diabetes, age, sex, duration of disease and liver involvement

Effects of diabetes on hepatic drug metabolism in man has not yet been adequately clarified. Two hundred ninety-eight diabetic patients, classified by type of the disease, age, gender, duration of therapy and liver involvement, were investigated. The antipyrine plasma clearance rate and cytochrome P450 content determinations in liver biopsies of subjects with diagnostic liver biopsy were used as indices of hepatic drug metabolising capacity. Drug metabolism was reduced as a function of age. Antipyrine elimination rate was dependent on the type of diabetes (type 1 versus type 2) and gender. Untreated type 1 patients eliminated antipyrine rapidly and insulin treatment normalised antipyrine elimination (clearance rates 89.5 +/- 20.3 versus 58.8 +/- 17.2 ml/min.; P<0.001). Males aged 16-59 years, but not over 60, who responded insufficiently to insulin therapy, had a rapid antipyrine elimination, which could be normalised by readjustment of insulin administration. Women with insufficient glucose control on insulin therapy had antipyrine elimination rate comparable to controls. Among type 2 diabetic patients, women metabolised antipyrine normally, but men over 40 years of age showed a reduced antipyrine metabolism.

IN CONCLUSION

Drug metabolism in diabetes is affected by the type of disease, therapy and its effectiveness, and age and gender of the patients. These factors should be taken into account when evaluating overall drug metabolism in diabetic patients. This is especially important when investigating pharmacokinetics of new drugs for diabetic patients at different phases of the disease.

Cardiovascular drug use and hospitalizations attributable to type 2 diabetes

OBJECTIVE

To investigate cardiovascular drug use and hospitalizations attributable to type 2 diabetes from 1 year before until 6 years after the start of oral antidiabetic therapy.

RESEARCH DESIGN AND METHODS

In this cohort study, 2,584 patients with type 2 diabetes were selected from the PHARMO Record Linkage System, comprising pharmacy records and hospitalizations for all 320,000 residents of six Dutch cities. Patients with type 2 diabetes were identified as incident oral antidiabetic drug users between 1992 and 1997. Nondiabetic subjects were 1:1-matched for age, sex, pharmacy, and index date and received no insulin, oral antidiabetic drugs, or glucose-testing supplies.

RESULTS

Patients with type 2 diabetes were more likely to use cardiovascular drugs (RR 1.28 [95% CI 1.23-1.34]) and to be hospitalized because of cardiovascular diseases (1.54 [1.33-1.78]) after the start of oral antidiabetic therapy than nondiabetic subjects. Differences between patients with type 2 diabetes and nondiabetic subjects lessened from 1 year before until 6 years after the start of oral antidiabetic therapy, reflected by decreasing attributable risks for diuretics, beta-blockers, calcium channel blockers, and cardiac and antithrombotic drugs. The difference in use of angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased. Cardiovascular hospitalizations attributable to type 2 diabetes were approximately 50% in the years close to the start of oral antidiabetic treatment and decreased to approximately 33% in the following years.

CONCLUSIONS

Although cardiovascular drug use and hospitalizations remained increased in patients with type 2 diabetes after the start of oral antidiabetic therapy, cardiovascular drug use attributable to type 2 diabetes decreased after the start of oral antidiabetic therapy, especially beta-blockers, whereas cardiovascular hospitalizations first decreased and then stabilized.

Use of antidiabetic and antihypertensive drugs in hospital and outpatient settings in Hong Kong

OBJECTIVE

To investigate the usage patterns of antidiabetic and antihypertensive drugs and to identify any discordance between recommended management guidelines and clinical practice in two study locations.

DESIGN

Prescription survey.

SETTING

A government- operated general outpatient clinic (GOPC) and a medical/geriatric specialist clinic (SC) affiliated with a regional hospital in the same district.

PATIENTS

Patients presenting with a prescription during the study period at the respective pharmacy were classified as having diabetes if at least one antidiabetic agent was prescribed and as having hypertension if a cardiovascular drug was prescribed in a hypotensive dosage.

MAIN OUTCOME MEASURE

The pattern of use of antidiabetic and antihypertensive drugs.

RESULTS

One thousand one hundred forty-four consecutive prescriptions were collected in the GOPC, and 1523 in the SC. Of 9.4% (n = 107) of patients were classified as having diabetes in the GOPC and 20.4% (n = 310) in the SC (p<0.001). Most patients with diabetes were taking oral hypoglycemic agents (98.1% in GOPC vs. 84.5% in SC). Glibenclamide was the sufonylurea used most often as monotherapy in both settings (50.5% in GOPC vs. 40.6% in SC). The combined use of a sulfonylurea with metformin was common in both settings (22.4% in GOPC vs. 28.4% in SC). Metformin monotherapy (1.9% in GOPC vs. 2.6% in SC) and combination treatment of insulin with an oral agent (0% in GOPC vs. 2.6% in SC) were rarely prescribed. In the GOPC, 24.5% (n = 280) of patients were prescribed an antihypertensive drug compared with 47.1% (n = 717) in the SC (p< 0.001). In the GOPC, the use of antihypertensive drugs was more prevalent in those with diabetes (53.5%) than in the remaining patients without diabetes (21.5%, p<0.001). In the SC, 51% of patients with diabetes were receiving antihypertensive drugs, but 40% of patients without diabetes were also receiving three treatments. In the GOPC, diuretics (indapamide 14.3% other 59%) and methyldopa (9.5%) were the most frequent choices of antihypertensive drugs when used as monotherapy in subjects without diabetes. In the SC, apart from diuretics (indapamide 12.9%, other 20.3%), beta-blockers (29%) also were prescribed frequently. If treated with only one antihypertensive drug, most patients with diabetes in the GOPC were prescribed indapamide (72.7%), and patients in the SC were treated mainly with angiotensin-converting enzyme inhibitors (35%) indapamide (22.5%), or calcium-channel blockers (13.8%).

CONCLUSIONS

In this prescription-based survey, diabetes mellitus and hypertension were found to be common diseases in general practice and in a hospital SC. Oral hypoglycemic agents were the main from of antidiabetic therapy in both settings, with glibenclamide being the most commonly prescribed sulfonylurea. The types of antihypertensive drugs used were different in the two locations and varied according to the coexistence of type II diabetes mellitus. Despite some potential limitations, prescription-based surveys are an easy and economical method for surveying the occurrence of some common medical problems and the pattern of drug use in a fairly large number of patients in health institutions.

Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.

Types of diabetes treatment in a total, Norwegian, adult population. The Nord-Trøndelag Diabetes Study

OBJECTIVES

To describe types of diabetes treatment in a total, adult population, including those on no antidiabetic medication, and to evaluate use of the defined daily doses in estimation of diabetes prevalence.

DESIGN

Cross-sectional epidemiologic survey applying patient-based questionnaires and clinical examinations approaching all inhabitants of > or = 20 years (85,100).

SETTING

Nord-Trøndelag county in the middle part of Norway.

SUBJECTS

All known diabetic patients in the county (2242) amongst all participants of > or = 20 years (76,855), registered in 1984-86.

INTERVENTIONS

Questionnaire data on type of diabetes treatment including drug doses, measurement of height and weight.

MAIN OUTCOME MEASURES

Distribution of types of treatment and of mean drug doses.

RESULTS

Of the diabetic patients of > or = 20 years of age, 20% used insulin, 39% oral hypoglycaemic agents and 41% no antidiabetic medication. Corresponding prevalence figures were 0.6%, 1.1% and 1.2%. Mean daily insulin dose per kg body weight was significantly higher in women than in men. Women with no antidiabetic medication stated a more restricted diet than men. The mean prescribed insulin dose was 14% higher than the defined daily dose, but the corresponding oral agent dose was lower than the defined daily dose.

CONCLUSIONS

Sales figures is a bad estimate of total diabetes prevalence due to the high proportion of diabetic patients using no antidiabetic medication. Correction is also necessary when the defined daily dose system is used to estimate the prevalence of medically treated diabetes.

The use of hypoglycaemic and cardiovascular drugs in 582 patients with diabetes mellitus. Description and quality assessment

The medication of 582 patients taking insulin or oral hypoglycaemic agents has been analysed. A characterization is given of the patients and their antidiabetic medication. Subsequently, a description of the use of cardiovascular drugs, in comparison with an age-matched control group, is presented. The diabetic population investigated has an average age of 67 years. Most cardiovascular agents, with the exception of thiazide diuretics, are used to a larger extent in the diabetic group in comparison with the control group. Non-selective beta-blockers, possibly hazardous in patients with diabetes mellitus, appear to be prescribed without restriction in the diabetic patients investigated. The results of this study suggest that the choice of drugs for the treatment of cardiovascular co-morbidity in patients with diabetes mellitus can be improved.

Factors associated with high-quantity prescriptions of benzodiazepines in Sweden

An important aspect, when discussing the prescribing and use of psychotropics, is the amount of drug prescribed at each visit. In this study the Swedish Diagnosis and Therapy Survey was used in order to analyze high-quantity prescriptions of benzodiazepines. The total amount of benzodiazepines prescribed--measured as defined daily doses (DDD)--was calculated for each visit. Prescriptions with quantities equal to or greater than the 90th percentile applied on the distribution of prescribed DDD per visit were defined as high-quantity prescriptions. Using this definition, prescriptions on 200 DDD or more--14.9% of all--were classified as high-quantity prescriptions. In the analysis the proportions of high-quantity prescription in different subgroups were compared. The study showed that there was a strong relationship between age of the patient and high-quantity prescriptions while the sex of the patient was of minor importance. Doctors specializing in internal medicine and psychiatrists prescribed high-quantity prescriptions to a greater extent than other doctors but differences with regard to the doctor's ages were small. Patients with sleeping disturbances obtained high-quantity prescriptions to a greater extent than other patients while patients with nervous problems obtained fewer. Patients with new prescriptions on benzodiazepines obtained high-quantity prescriptions to a lesser extent than patients making repeat visits. In addition the study showed that it was not as common with high-quantity prescriptions in the three major cities and in the most sparsely populated communities as in mid-sized communities.

Psychiatric morbidity in young adults with insulin-dependent diabetes mellitus

Psychiatric disorder and sub-threshold psychological distress were more common in 113 young men and women with insulin-dependent diabetes living in a defined area than in comparable general population samples. Twelve per cent of men and 19% of women were classified by the PSE as psychiatric 'cases'. Forty per cent of women and 47% of men reported at least one major social problem; effects of diabetes on everyday activities were common. There were associations between medical and social variables. The clinical implications are discussed.

The effects of diabetes mellitus on pharmacokinetics and pharmacodynamics in humans

The article reviews the effect of diabetes on the pharmacokinetics and pharmacodynamics of drugs in humans. For most drugs which cross the gastrointestinal wall by passive diffusion, oral absorption is unlikely to be affected by diabetes, although a delay in the absorption of tolazamide and a decrease in the extent of absorption of ampicillin have been reported. Subcutaneous absorption of insulin is more rapid in diabetic patients, whereas the intramuscular absorption of several drugs is slower. The binding of a number of drugs in the blood is reduced in diabetes, which may be due to glycosylation of plasma proteins or displacement by plasma free fatty acids, the level of which is increased in diabetic patients. Plasma concentrations of albumin and alpha 1-acid glycoprotein do not appear to be changed by the disease. The distribution of drugs with little or no binding in the blood is generally not altered, although the volume of distribution of phenazone (antipyrine) is reduced by 20% in insulin-dependent diabetes mellitus (IDDM). In contrast to animal studies, the metabolic clearance of most drugs in humans appears to be unaffected or slightly reduced by the disease. The presence of fatty liver in non-insulin-dependent diabetes mellitus (NIDDM) may contribute to a reduced hepatic clearance, whereas decreased binding in the blood may cause an increase in clearance. The effect of diabetes on hepatic blood flow in humans appears to be unknown. Diabetes affects kidney function in a significant number of diabetic patients. During the first 10 years after the onset of the disease, glomerular filtration is elevated in these patients. Thus, the renal clearance of a number of antibiotics has been shown to be increased in diabetic children. As the disease progresses, renal function is impaired and glomerular function declines from the initial elevated state. In diabetic adults the renal clearance of drugs either is comparable with that found in nondiabetic individuals or is reduced. A limited number of studies have been conducted comparing the dose-response of cardiovascular drugs in diabetic patients with that in nondiabetic controls. Decreased, increased and unchanged responses have been reported. It is apparent that in some cases an altered response may be observed for a drug when administered to a diabetic patient compared with a similar nondiabetic individual. At the present time, it is not possible to ascertain whether these studies reflect true pharmacodynamic changes or merely alterations in pharmacokinetics.(ABSTRACT TRUNCATED AT 400 WORDS)

Epidemiological use of drug prescriptions as markers of disease frequency: an Italian experience

All Italian citizens are covered by the National Health Service (NHS) and medical records of individual drug prescriptions are routinely collected and processed. A procedure entitled EPIFAR has been developed which, on the basis of a computer routine, makes it possible to trace back the prescription history of each individual included in the NHS. The validity of information gathered through the EPIFAR procedure to provide estimates of tuberculosis (TB) prevalence has been evaluated. A comparison with routine surveillance data has been made. The EPIFAR procedure identified a total figure of TB patients seven times higher than that from official notifications. A sample survey was conducted among the prescribing physicians in order to quantify the proportion of TB cases among subjects receiving prescriptions of anti-TB drugs. According to general practitioner recall 66.4% of the patients were treated because of TB diagnosis, TB prophylaxis and TB relapse.

Drug consumption in elderly subjects with occult fasting hyperglycaemia

Drug consumption was studied in 87 persons with occult fasting hyperglycaemia and compared with sex- and age-matched non-diabetic controls all selected by screening a well-defined population aged 60-74 years. The daily use of prescribed and nonprescribed drugs was established by questionnaires and interviews. Sixty-nine percent of subjects with fasting hyperglycaemia used drugs daily compared with 46% of controls (P less than 0.005). The difference was most pronounced among men. The median use of defined daily doses in those using drugs was not significantly different in the two groups. The main drug usage in both subjects with fasting hyperglycaemia and controls was in the cardiovascular medication group. More than half (59%) of the subjects with fasting hyperglycaemia used cardiovascular drugs compared with 27% of controls (P less than 0.0001). There were no significant differences in the other medication groups. Our results may reflect an increased morbidity from cardiovascular diseases among the elderly with occult fasting hyperglycaemia, and they seem to be comparable with the results on drug consumption found in the elderly with known diabetes.

Drug consumption in elderly diabetics

The drug use in 228 persons with diabetes was studied and compared with that of sex- and age-matched non-diabetic controls--all of whom were found by the screening of a well-defined Danish population aged 60-74 years. Ninety per cent of the diabetics had non-insulin-dependent diabetes mellitus (NIDDM), as evaluated by a glucagon-C-peptide test. Information on daily use of prescribed and non-prescribed drugs was obtained by questionnaires and interviews. More than 80% of the diabetics used drugs daily, compared to 55% of control subjects (P less than 0.00001). Among subjects using drugs diabetics, on average, used 70% more defined daily doses (DDD) than controls, even when antidiabetics were excluded. There was no difference in the number of drug users among subgroups of diabetics when divided according to antidiabetic treatment but tablet-treated diabetics, on average, used 20% fewer DDD than other diabetics. Cardiovascular drugs were the most commonly used drugs. Diabetics in all antidiabetic treatment groups used significantly more cardiovascular drugs than non-diabetics. Diabetics treated with oral antidiabetics used fewer cardiovascular drugs than insulin- and diet-treated diabetics. The estimated cost of drug therapy was more than 2.5 times higher for diabetics than for the control group. Our results reflect the increased morbidity among elderly diabetics and emphasise, together with other aspects of costs of diabetes in the elderly, the need for allocating resources for the prevention of NIDDM instead of the treatment of its complications.

Heavy users of prescription drugs--mortality and stability in use patterns

Longitudinal analyses of heavy users of prescription drugs were carried out in a geographically defined population in mideastern Sweden. During the period 1976-1983 the individual stability in heavy use of prescription drugs was analysed in heavy users identified in 1975. Mortality of heavy and nonheavy users during the same period was also studied. The 10% with the heaviest use accounted for more than 40% of total drugs prescribed. A substantial proportion of heavy users continued heavy use for eight or more years. These continuing heavy users accounted for more than 7% of total drugs prescribed during 1983. Individual stability in heavy use of prescription drugs over time varied with age. Continued heavy use was not common in the youngest heavy users, whereas a substantial proportion of older heavy users continued with such use over time. There were no differences between men and women in continued heavy use. Heavy users with use of hormonal drugs, including anti-diabetics, or use of psychotropics had a greater tendency towards continued heavy use, compared with heavy users without such use. Heavy users with use of antibiotics, systemic drugs for allergies or drugs for ear, nose, and throat conditions had a lower tendency towards continued heavy use over time, compared with other heavy users. Heavy users of prescription drugs had a higher mortality, compared with nonheavy users.

Psychiatric disorders and diabetes--results from a community study

In the Upper Bavarian Field Study a total of 1536 persons (15 years and older) were interviewed by research psychiatrists. The prevalence of diabetes (ICD 250) identified by the interviewer and/or the primary care physician was 4.0%. Since the number of diabetics among the younger age groups was relatively low (n = 7) and in order to obtain a more homogeneous study group, only those over the age of 55 were considered in further analysis. Diabetics were compared with a control group of persons with another chronic medical condition of similar clinical severity and a control group without a somatic disorder. The sex- and age-adjusted prevalence of psychiatric disorders identified with the aid of the Clinical Interview Schedule was significantly higher among diabetics (43.1%) and persons with other chronic medical conditions (50.7%) in comparison to the healthy control group (26.2%). The difference was mainly due to mild psychiatric disorders and those suffering from depression. No statistically significant association was found between diabetes and moderate to severe mental disorders, the use of psychotropic drugs and previous psychiatric treatment.

An estimation of the prevalence of diabetes mellitus in Norway. A prescription registration study

A prevalence of 0.9% for drug-treated diabetes mellitus was calculated (male 0.8; female 1.0) for Norway, based upon a survey of 6777 prescriptions of antidiabetic drugs at 61.5% of Norwegian pharmacies during a four-week period in 1984. A male dominance was found below the age of 50 years, gradually shifting towards female dominance among the elderly. These findings are in accordance with a population screening on diabetes mellitus in the county of Nord-Trøndelag, and may indicate that prescription data can be a valuable source in the estimation of sex and age prevalence figures. Compared to screening, prescription studies are more simple to perform and cheaper, and can provide valuable background information in primary health care.

Use of antibiotics and prescription drugs in general during the first 9 years of life in a Swedish community

The use of antibiotic drugs and of prescription drugs in general during the first 9 years of life was studied among all 1701 children born in a Swedish municipality. Cumulative proportions of children who had received one or more prescriptions for any type of drug and for different groups of antibiotic drugs were estimated by life-table methods. The effects on drug use of the gender and the birth order of the child along with the age, citizenship and marital status of the mother were analysed by Cox's proportional hazards regression model. Half of the children had received at least one prescription for any drug after 0.6 years and at least one prescription for any antibiotic drug after 1.8 years. Higher proportions of children with prescriptions for all drugs and for all antibiotic drugs were found among males than females, among those with older siblings compared with first-borns and among children of younger mothers compared with those of older mothers.

Diagnoses associated with the prescription of psychotropic drugs at a Swedish health centre

Data on drug prescribing to residents of the municipality of Tierp in 1978 were linked to data on visits to the Tierp health centre in order to examine which diagnoses were associated with psychotropic drug prescribing. The diagnostic patterns were analyzed with respect to sex, age, and level of drug use of patients. Only one quarter of the patients for whom psychotropic drugs were prescribed in connection with a visit to the health centre were also given a psychiatric diagnosis. Even among those patients who were prescribed five or more psychotropic drugs, only four out of ten had a psychiatric diagnosis. Among those patients who were prescribed an antidepressant, only six out of ten had a psychiatric diagnosis. A relation between psychotropic drug use and certain non-psychiatric diagnoses such as hypertension, diabetes and ischaemic heart disease was observed.

Psychotropic drug use in a Swedish community--the importance of demographic and socioeconomic factors

In this study the importance of demographic and socioeconomic factors for the use of psychotropic drugs in the general population of a Swedish community was studied using data from a research registry on prescriptions. The study showed that age, gender, marital status, socioeconomic status and distance to the health center had independent and significant effects on the use of psychotropic drugs. Age was of very great importance; the proportion of users was more than ten times greater among individuals aged 75-84 years than among those aged 18-34 years. Furthermore it was approximately twice as common with those drugs among women as compared to men. Differences with regard to marital and socioeconomic status were also present but these were generally small except in certain groups such as men aged 35-44 who were not employed, divorced men aged 45-54 and 55-64 years and single women aged 35-44 years.