GL and PKK carried out data analysis. insurance status, morbidity and pharmacotherapy. Patients with Diabetes mellitus type 1 (DM1) were excluded from the study. Results From the family practices collaborating in the CONTENT research network, there were 7298 patients treated with pharmacotherapeutic agents for DM2 between 01.09.2009 and 31.08.2014. 586 (8.03?%) of these patients had private insurance. Prescriptions for the incretin mimetics were 40.6?% higher (9.7 vs. 6.9?%; class of diabetic medications that in some cases have been withdrawn completely from the market and in other cases are no longer recommended due to concerns of increased incidence of coronary heart disease and myocardial infarction or possible links to bladder cancer associated with their use [29, 30]. Currently there is still disagreement between different expert associations regarding the potential therapeutical advantage of the GLP-1 and DDP-4 agents and the potential risks and side effects of such a therapy [31, 32]. Critical reflection and reference to clinical guidelines and current literature belongs to good medical practice when making prescribing decisions and this is equally relevant for prescription of DPP-4-inhibitors and GLP-1-agonists, the case under discussion in this paper. It certainly has to be recognised that with more or Cilengitide less free prescribing in Germany for privately insured patients of new classes of diabetic drugs such as the incretin mimetics, these patients have a potential therapeutic advantage over patients with statutory health insurance due Cilengitide to easier access. However, it should be emphasized that in all cases, good medical practice for prescription decisions related to DPP-4-inhibitors and GLP-1-agonists should be based on potential therapeutic advantages and potential disadvantages/risks of the pharmacotherapeutic agents and not eligibility for reimbursement according to private or statutory health insurance. The strength of this study include the ability to compare data from patients with either private or statutory health insurance receiving primary health care services from the same FP, due to information being continuously collated in a health services research Register from the family practices collaborating in Cilengitide CDK2 the CONTENT research network. In contrast to other known German registers such as DiaRegis [33] or SIRTA [34], our Register was not explicitly established to investigate research questions related to DM2. Data from this Register provides a comprehensive overview of multiple health issues and their treatments. Currently, the Register has collected morbidity and health services data from a total of 3M Doctor-Patient contacts. The Research Network CONTENT has much future potential in terms of synergistic effects, in cooperation with other existing registers, to address research needs and produce evidence with a focus on primary care health services by FPs for patients with DM2. Limitations related to this study include the use of routine data collected from family practices collaborating in the CONTENT research network. Data on prescriptions made by specialists (particularly Internal Medicine) were not available. In addition, other factors taken into account in therapeutic decision-making beside the socio-demographic data (e.g. occupation, leisure activities, driving) were not available in the register, and could be relevant. Moreover, is has to be taken into account that the data was derived from voluntarily participating FPs within a regional German cluster (mainly Baden-Wrttemberg and Hesse, 2 of 16 federal states of Germany). These factors need to be taken into consideration in terms of the representativeness of the results. Conclusions In this sample population of German patients with DM2, we observed statistically significant differences in prescription patterns according to Cilengitide the patients health insurance status for the incretin mimetics. This is clearly due to differences in the eligibility for reimbursement according to patients health insurance status. Of concern, is the fact that whether incretin mimetics pose specific long term risks for particular patients is yet to be determined. In conclusion, whether a patient has private or statutory health insurance should not determine pharmacotherapeutic advantages or risks for patient groups with a particular health problem. This needs to be taken into account by key stakeholders and decision-makers in the development of new strategies and measures in health care service provision. Acknowledgements The authors would like to thank the BMBF (German Federal Ministry of Education and Research) for funding the study. Moreover, we want to thank the participating family practitioners for their continuous data supply. Authors contributions GL and JS initiated and designed the study. GL and RL coordinated the study. GL and PKK carried out data analysis. GL, SB (native English speaker) and RL wrote the manuscript. All authors (GL, SB, JS, PKK and RL) commented on the draft and approved the final version of the manuscript. Competing interests The authors declare that they have no competing interests. Abbreviations BMBFBundesministerium fuer Bildung und Forschung (Federal Ministry of Education and Research)CIConfidence IntervalCONTENTCONTinuous morbidity registration Epidemiologic NeTworkDDP-4Dipeptidyl peptidase-4DM1Diabetes mellitus type 1DM2Diabetes mellitus type 2EMAEuropean Medicines AgencyFDAFood and Drug.
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