{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T16:52:23Z","timestamp":1768927943213,"version":"3.49.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,10,8]],"date-time":"2019-10-08T00:00:00Z","timestamp":1570492800000},"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":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the patterns and predictors of pharmacological treatment initiation for type 2 diabetes and whether treatment initiation is consistent with Australian clinical practice guidelines that recommend metformin monotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals aged 40\u201399 years initiating a non\u2010insulin type 2 diabetes medication between July 2013 and February 2018 were identified from a 10% random national sample of pharmacy dispensing data. Logistic regression was used to estimate odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) and 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s) for the predictors of initiating sulfonylurea monotherapy, non\u2010guideline monotherapy and combination therapy compared with metformin monotherapy. Predictors included age, sex, initiation year and comorbidities determined using the Rx\u2010Risk comorbidity index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 47\u00a0860 initiators, [47% women, mean age 60.7 (<jats:sc>sd<\/jats:sc> 12.1) years], 85.8%, 4.6%, 1.9% and 7.7% received metformin monotherapy, sulfonylurea monotherapy, non\u2010guideline monotherapy and combination therapy, respectively. Increasing age was associated with increasing odds of initiating sulfonylurea monotherapy and non\u2010guideline monotherapy. Combination therapy initiation was less likely in women (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.74, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.69\u20130.79) and people with more comorbidities (e.g. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.36, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.29\u20130.44 for seven or more comorbidities vs. no comorbidities) but more likely in congestive heart failure (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.42, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.22\u20131.65), cerebrovascular disease (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.50, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.32\u20131.69) and dyslipidaemia (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.29, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.19\u20131.40).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Treatment initiation in Australia is largely consistent with clinical practice guidelines, with 86% of individuals initiating metformin monotherapy. Initiation on combination therapy was more common in men and in those with fewer comorbidities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14149","type":"journal-article","created":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T00:48:27Z","timestamp":1569545307000},"page":"1367-1373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pharmacological treatment initiation for type 2 diabetes in Australia: are the guidelines being followed?"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9256-2216","authenticated-orcid":false,"given":"S. J.","family":"Wood","sequence":"first","affiliation":[{"name":"Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. J.","family":"Magliano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventative Medicine Monash University Melbourne"},{"name":"Baker Heart and Diabetes Institute Melbourne"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. S.","family":"Bell","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne"},{"name":"NHMRC Cognitive Decline Partnership Centre, Hornsby Ku\u2010ring\u2010gai Hospital Hornsby"},{"name":"Sansom Institute, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. E.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute Melbourne"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. S.","family":"Keen","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Ilom\u00e4ki","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne"},{"name":"Department of Epidemiology and Preventative Medicine Monash University Melbourne"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,8]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Medicines for the Treatment of Diabetes","author":"Drug Utilisation Sub Committee","year":"2017"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4158\/CS-2017-0153"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2016.11.005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2441"},{"key":"e_1_2_9_6_1","volume-title":"General Practice Management of Type 2 Diabetes 2016\u20132018","author":"Royal Australian College of General Practitioners (RACGP)","year":"2016"},{"key":"e_1_2_9_7_1","volume-title":"Therapeutic Guidelines: Endocrinology","year":"2013"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-018-0266-3"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15298"},{"key":"e_1_2_9_10_1","volume-title":"Metformin Use in Patients with Historical Contraindications or Precautions","author":"Crowley MJ","year":"2016"},{"key":"e_1_2_9_11_1","first-page":"811","article-title":"Fixed dose combination diabetes medicines usage in the Australian veteran population","volume":"40","author":"Gadzhanova S","year":"2011","journal-title":"Aust Fam Physician"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dcS15-3007"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3756"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012461"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021122"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022768"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1586\/17512433.2016.1159512"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-018-9703-2"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2015.08.004"},{"key":"e_1_2_9_20_1","volume-title":"Metformin Use in Patients with Historical Contraindications or Precautions","author":"Crowley MJ","year":"2016"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.12.011"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-017-0694-4"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13108"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-2368"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12233"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2011.01416.x"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0802743"},{"key":"e_1_2_9_28_1","unstructured":"Australian Bureau of Statistics.Patient Experiences in Australia: Summary of Findings 2014\u201015. cat. no. 4839.0. 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