Comparison of anti-diabetic drug prescribing in children and adolescents in seven European countries

Authors

  • Antje Neubert,

    Corresponding author
    1. Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London and The Institute of Child Health, University College London, London, UK
    2. Department of Paediatric and Adolescent Medicine, University Hospital Erlangen-Nuremberg, Erlangen, Germany
    Search for more papers by this author
  • Yingfen Hsia,

    1. Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London and The Institute of Child Health, University College London, London, UK
    Search for more papers by this author
  • Lolkje T. W. de Jong-van den Berg,

    1. Unit Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
    Search for more papers by this author
  • Katrin Janhsen,

    1. Centre for Social Policy Research (ZeS), University of Bremen, Bremen, Germany
    2. LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
    Search for more papers by this author
  • Gerd Glaeske,

    1. Centre for Social Policy Research (ZeS), University of Bremen, Bremen, Germany
    Search for more papers by this author
  • Kari Furu,

    1. Department of Pharmacoepidemiology, Norwegian Institute of Public Health and Department of Pharmacy, University of Tromsø, Tromsø, Norway
    Search for more papers by this author
  • Helle Kieler,

    1. Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
    Search for more papers by this author
  • Mette Nørgaard,

    1. Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
    Search for more papers by this author
  • Antonio Clavenna,

    1. Laboratory for Mother and Child Health, Department of Public Health ‘Mario Negri’ Institute for Pharmacological Research, Milan, Italy
    Search for more papers by this author
  • Ian C. K. Wong

    1. Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London and The Institute of Child Health, University College London, London, UK
    2. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
    Search for more papers by this author

Dr Antje Neubert PhD, Department of Paediatric and Adolescent Medicine, University Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany. Tel.: +49 09131 8541237, Fax: +49 09131 8536873, E-mail: antje.neubert@uk-erlangen.de

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• The incidence of both type 1 and type 2 diabetes is rising among children and adolescents.

• Data on the prevalence of type 1 and type 2 diabetes are limited.

• Routine clinical databases can be used to study the prevalence and epidemiology of treatment, depending on the completeness of data capture and their representativeness of the whole population.

WHAT THIS STUDY ADDS

• The prevalence of insulin prescribing appears to vary among countries, being highest in Sweden (3.5 per 1000 population) and lowest in Italy (1.1 per 1000 population).

• The prevalence of oral anti-diabetic prescribing ranges from 0.08 per 1000 population in Sweden and Germany to 0.21 per 1000 population in the UK; however, the total number of patients receiving oral anti-diabetics is low.

• It is possible to use the same study protocol across clinical databases in Europe to study the prevalence of type 1 diabetes in children.

• Routine clinical databases can identify the prevalence of type 1 diabetes prescribing and could be used to study the secular changes in disease prevalence in children.

AIMS The aim of this study was to compare the prevalence of diabetes in children across seven European countries, when using prescribing of anti-diabetics as a proxy for diabetes. A secondary aim was to assess the potential for collaboration between countries using different databases in diabetes research.

METHODS Data were obtained from population-based clinical databases in seven European countries. The study population comprised children aged 0–18 years. Prescriptions were categorized using the Anatomic Therapeutic Chemical (ATC) classification. The one-year user prevalence in 2008 was calculated for each country and stratified by age and sex.

RESULTS We studied a total of 5.8 million children and adolescents. The prevalence of insulin prescribing varied between 1.1 and 3.5 per 1000 population, being highest in Sweden and lowest in Italy. In all countries, novel insulin analogues were the most commonly used insulins. The prevalence of oral anti-diabetic prescribing ranged from 0.08 per 1000 individuals in Sweden and Germany to 0.21 per 1000 population in the UK. Overall, the absolute number of oral anti-diabetic users was very low.

CONCLUSION This study shows that there is a varying frequency of type 1 diabetes in children and adolescents across Europe. We also demonstrated that it is possible to obtain similar information from different clinical databases within Europe, which would allow continuous monitoring of type 1 diabetes. Owing to the lack of indications in most of the databases, this approach is less suitable for type 2 diabetes.

Ancillary