Diabetes, Hypertension, and Depression Treatments Vary by Location

Patients with certain chronic conditions often receive different treatments depending on where they live, results of a new analysis have revealed.

The Observational Health Data Sciences and Informatics (OHDSI) project used patient data from 250 million individuals from 4 countries (the United States, Japan, the United Kingdom, and South Korea) to investigate how treatment pathways for type 2 diabetes (T2D), hypertension, and depression may vary by location across large, diverse populations. Investigators assessed treatment data from the patients’ initial diagnosis through their first 3 years of therapy.

Across the 3 common conditions studied, first-line treatments for T2D were the most homogenous. Three-quarters of patients with T2D initially received the oral medication metformin, and it remained the only diabetes medication for 29% of patients. Meanwhile, secondary treatments for T2D varied greatly.

Hypertension treatments were more varied. Lisinopril was the most common choice as a single therapy. Hydrochlorothiazide was predominant as a starting medication, but it was rarely a sole therapy.

In the depression cohort, no single drug stood out as the most commonly prescribed, and all choices fell within a relatively narrow band of 6 classes. This could be explained by a relative lack of concrete treatment guidelines.

Notably, 10% of patients with T2D, 24% of patients with hypertension, and 11% of patients with depression were found to have a treatment pathway that was shared with no one else.

Treatment patterns varied by site, sometimes by country, and sometimes by practice type—suggesting that treatment plans might not be generalizable across all patient populations and settings.

“The world is moving toward more consistent therapy over time across diseases and across locations. Nevertheless, outliers [highlight] the danger of drawing broad inference from single-site or even single-country observational studies,” the authors concluded.

For now, clinicians should keep in mind that drug regimens for T2D, high blood pressure, and depression aren’t always one-size-fits-all. Therefore, it’s highly important for clinicians to review a patient’s medical records and treatment history and to collaborate with the primary care physician when developing individualized management plans.