{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:28:37Z","timestamp":1778657317353,"version":"3.51.4"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,1,21]],"date-time":"2013-01-21T00:00:00Z","timestamp":1358726400000},"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":["Diabet. Med."],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To examine temporal changes in progression to second\u2010line therapies among older patients with diabetes newly treated with metformin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a population\u2010based study among residents of Ontario, Canada aged 66\u00a0years and older with diabetes newly treated with metformin monotherapy in 1997, 2000, 2003 or 2006. Each annual cohort was followed until progression to a second oral hypoglycaemic agent, insulin or until 31 December 2010. Time to progression to a second oral hypoglycaemic agent or insulin was compared across the cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the four annual cohorts, we identified a total of 46\u00a0104 people newly treated with metformin monotherapy. The median time to progression to any second diabetes therapy lengthened significantly over time, from 5.0\u00a0years in 1997 to 6.1\u00a0years in 2003 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001). Similarly, the time to progression to insulin lengthened over the study period (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). Furthermore, the choice of second\u2010line therapy changed over time. While 80.7% of new metformin users in 1997 progressed to glyburide therapy as second\u2010line treatment, the corresponding figure by 2006 was only 45.1% as newer treatment options emerged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although recent guidelines recommend aggressive intensification of oral therapy for patients with Type 2 diabetes, older Ontarians with diabetes who started metformin in 2006 remained on monotherapy for longer than those who started in 1997. Furthermore, although there is no consensus regarding a preferred second\u2010line therapy, the introduction of new alternatives has led to greater variation in the selection of second\u2010line therapies in this population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.12049","type":"journal-article","created":{"date-parts":[[2012,10,18]],"date-time":"2012-10-18T18:37:11Z","timestamp":1350585431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Progression through diabetes therapies among new elderly users of metformin: a population\u2010based study"],"prefix":"10.1111","volume":"30","author":[{"given":"T.","family":"Gomes","sequence":"first","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"},{"name":"The Leslie Dan Faculty of Pharmacy University of Toronto"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. N.","family":"Juurlink","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"},{"name":"Department of Medicine Sunnybrook Health Sciences Centre"},{"name":"Departments of Medicine"},{"name":"Pediatrics"},{"name":"Health Policy Management and Evaluation University of Toronto"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. R.","family":"Shah","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"},{"name":"Department of Medicine Sunnybrook Health Sciences Centre"},{"name":"Departments of Medicine"},{"name":"Health Policy Management and Evaluation University of Toronto"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. R.","family":"Hellings","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. M.","family":"Paterson","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"},{"name":"Department of Family Medicine McMaster University"},{"name":"Centre for Evaluation of Medicines St Joseph's Healthcare"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. M.","family":"Mamdani","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences"},{"name":"The Leslie Dan Faculty of Pharmacy University of Toronto"},{"name":"Departments of Medicine"},{"name":"Health Policy Management and Evaluation University of Toronto"},{"name":"Keenan Research Centre of the Li Ka Shing Knowledge Institute St Michael's Hospital Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,1,21]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1","article-title":"The projection of prevalence and cost of diabetes in Canada: 2000 to 2016","volume":"28","author":"Ohinmaa A","year":"2004","journal-title":"Can J Diabetes"},{"key":"e_1_2_8_3_1","volume-title":"National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011","author":"Centers for Disease Control and Prevention","year":"2011"},{"key":"e_1_2_8_4_1","first-page":"3.51","volume-title":"Diabetes in Ontario: An ICES Practice Atlas","author":"Shah BR","year":"2003"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0413"},{"key":"e_1_2_8_6_1","first-page":"S1","article-title":"Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada","volume":"32","author":"Canadian Diabetes Association Clinical Practice Guidelines Expert Committee","year":"2008","journal-title":"Can J Diabetes"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-156-3-201202070-00011"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP.15.6.540"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0b013e318123f771"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0b013e3181afbf51"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2007.01369.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.110178"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.954"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2942"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072761"},{"key":"e_1_2_8_16_1","unstructured":"US Food and Drug Administration.FDA Drug Safety Communication: Updated Risk Evaluation and Mitigation Strategy (REMS) to Restrict Access to Rosiglitazone\u2010Containing Medicines Including Avandia Avandamet and Avandaryl.2011. Available athttp:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm255005.htmLast accessed 22 October 2012."},{"key":"e_1_2_8_17_1","first-page":"697","article-title":"Clinical practice guidelines for treatment of diabetes mellitus","volume":"147","author":"Expert Committee of the Canadian Diabetes Advisory Board","year":"1992","journal-title":"CMAJ"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.12049","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.12049","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T03:46:18Z","timestamp":1697600778000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.12049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1,21]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013,2]]}},"alternative-id":["10.1111\/dme.12049"],"URL":"https:\/\/doi.org\/10.1111\/dme.12049","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,1,21]]},"assertion":[{"value":"2012-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-10-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-01-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}