{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:34:25Z","timestamp":1763037265021,"version":"3.40.5"},"reference-count":50,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T00:00:00Z","timestamp":1548288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Use of glucose\u2010lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data of 36\u2009924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age\u2010, sex\u2010 and racially\u2010standardized proportions of patients (a) prescribed with each class of glucose\u2010lowering agent, (b) on various glucose\u2010lowering regimens, and (c) had an HbA<jats:sub>1c<\/jats:sub> of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Utilization of dipeptidyl peptidase\u20104 inhibitors (1.2% to 31.2%) and sodium\u2010glucose cotransporter\u20102 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The proportion of patients with HbA<jats:sub>1c<\/jats:sub> of 8% or more increased (33.7% to 36.0%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient\u2010years, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) also rose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medication utilization patterns have changed significantly over the past 11\u2009years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.12886","type":"journal-article","created":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T06:44:50Z","timestamp":1545029090000},"page":"573-581","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017"],"prefix":"10.1111","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4266-1363","authenticated-orcid":false,"given":"Yan Zhi","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Pharmacy Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1108-1494","authenticated-orcid":false,"given":"McVin Hua Heng","family":"Cheen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su\u2010Yen","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong Mong","family":"Bee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paik Shia","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giat Yeng","family":"Khee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Thumboo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-004-1334-6"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7258.405"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7134.823"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci18-0007"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2010.09.010"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2016.01.019"},{"issue":"1","key":"e_1_2_7_8_1","first-page":"S1","article-title":"Standards of medical care in diabetes \u2010 2018","volume":"41","author":"American Diabetes Association","year":"2018","journal-title":"Diabetes Care."},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.117.311588"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.03.009"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615692"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2018.01.002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.4158\/CS-2017-0153"},{"key":"e_1_2_7_14_1","unstructured":"Agency for Care Effectiveness Ministry of Health Singapore. 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