Disparity in Guideline‐Based Antidiabetic Drugs Prescribing for Type 2 Diabetes Patients in Primary Healthcare Facilities Across China, 2017–2019

Purpose The purpose of this study is to evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with Type 2 diabetes at primary healthcare facilities (PHFs) in China. Methods We collected outpatient‐visit prescriptions from 363 PHFs in 31 cities covering eastern, central, and western regions of China. The visits of adult patients with Type 2 diabetes diagnosis were collected and classified the antidiabetic medication pattern of each patient use as recommended or non‐recommended according to Chinese guidelines. We then calculated the proportion of guideline‐recommended patterns and the average monthly cost for each pattern, overall and by region. Results Of 33 519 prescriptions for Type 2 diabetes, most (73.9%) were for guideline‐recommended antidiabetic treatments. The proportion of guideline‐recommended prescriptions varied by region (eastern [75.9%], central [87.5%], and western [59.7%]). Metformin monotherapy was the most common guideline‐recommended treatment in all three regions (eastern [20.1%], central [28.0%], and western [24.6%]). The most common non‐guideline‐recommended treatments were monotherapy of insulin (eastern [16.5%], central [5.1%], and western [25.7%]) and traditional Chinese antidiabetic medicines (eastern [5.6%], central [5.7%], and western [11.1%]). The average monthly costs were lower for guideline‐recommended treatments compared to non‐recommended treatments in all regions (eastern [13.6 ± 15.4 USD vs. 28.1 ± 22.0 USD], central [9.8 ± 10.9 USD vs. 28.7 ± 19.4 USD], and western [17.9 ± 21.4 USD vs. 30.3 ± 23.6 USD]). Conclusions The majority of patients with Type 2 diabetes received guideline‐recommended antidiabetic medications at PHFs in China, with only half of the prescriptions containing guideline‐recommended metformin. Utilization of guideline‐recommended therapies differed across regions. Tailored interventions to promote evidence‐based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.