Type 2 Diabetes Treatment Patterns Across Europe

Abstract

A359other groups, namely sulfonylureas and thiazolidinediones, it has been declining each year on average by 2 % and 15 %, respectively. ConClusions: The uptake of incretin-based drugs since 2008 has been rapid and their utilization keeps rising, apparently at the expense of other drugs, namely older sulfonylurea derivatives and thiazolidinediones. Consequently the overall public expenditure on anti-diabetic therapy has been increasing.objeCtives: This study describes the extent of non-adherence (NA) and non-persistence (NP) with Glucagon-like peptide 1 agonists (GLP-1) and oral anti-diabetic (OAD) therapy in T2DM patients in clinical practice in Germany. Methods: Claims data from a German sickness fund (AOK Plus) from 2010-2012 were used to identify patients with ≥ 1 diagnosis for T2DM. NA/NP were measured for patients initiating new T2DM medication (no prescription of respective medication in prior 6 months) over a minimum of 12 months. A 100% adherence to therapy was assumed equivalent to the drug-specific DDD (defined daily dosage). NP was defined as a medication gap ≥ 90 days. Adherence was calculated via medication possession ratios (MPR), NA was defined as MPR< 80%. Descriptive analyses with percentage of patients affected by NP and/or NA were conducted. Results: The NP analysis, included 2,490/42,891 T2DM patients initiating GLP-1s/OADs. Among GLP-1 patients, 408/1,727/135 received twice-daily (BID; exenatide)/once-daily (OD; liraglutide)/onceweekly (OW; exenatide) therapies. Average age for GLP-1/OAD users was 56 (SD 10.8) /67 (SD 12.6) years. After 12 months, the percentage of patients with NP was 36.83% (all GLP-1s), 42.65% (BID), 37.64% (OD), 27.41% (OW), and 55.87% (OAD). The NA analysis included 2,154/34,128 T2DM patients initiating GLP-1/OAD therapy with ≥ 1 follow-up prescription. Average age was 56 (SD 10.6) /66 (SD 12.2) years. Average MPR was 88.2% (all GLP-1s), 87.8% (BID), 88.2% (OD), 95.0% (OW), and 63.2% (OAD). Percentage of patients affected by NA was 21.96% (all GLP-1s), 23.98% (BID), 22.00% (OD), 5.74% (OW), and 65.82% (OAD). ConClusions: In this German dataset, overall patients with T2DM had low rates of adherence and persistence despite the chronic nature of the disease and clinical sequelae. Higher adherence and persistence rates were observed with GLP-1s than with OAD medications and also with less frequently dosed GLP-1s.

Incidence, prevalence and mortality of type 2 diabetes requiring glucose-lowering treatment, and associated risks of cardiovascular complications: a nationwide study in Sweden, 2006–2013

“…Compared with other European countries, Sweden had the highest use of insulin among GLDs (about 28%), followed by ∼20% use in the Netherlands, Spain and the UK [29]. The reported decreased use of insulin secretagogues is in line with rest of Europe [29]. Despite the steep increase in insulin use, the use of blood glucose test strips decreased by about 30%, which was an unexpected finding in our study.…”

“…Metformin was, as expected, the GLD with the highest level of filled prescriptions and fairly constantly prescribed. Compared with other European countries, Sweden had the highest use of insulin among GLDs (about 28%), followed by ∼20% use in the Netherlands, Spain and the UK [29]. The reported decreased use of insulin secretagogues is in line with rest of Europe [29].…”

Novel oral glucose‐lowering drugs are associated with lower risk of all‐cause mortality, cardiovascular events and severe hypoglycaemia compared with insulin in patients with type 2 diabetes

“…The present results represent, to our knowledge, the first evidence of the cardiovascular benefit of an SGLT2 inhibitor (here, dapagliflozin), in a real clinical setting, supporting a class effect by complementing what has previously been shown, both in a randomized controlled cardiovascular outcome trial and a meta‐analysis . The beneficial associations of lowered CVD and mortality risks in the present study should also be interpreted in the context of a T2D population with a lower CVD burden at baseline compared with the clinical randomized trial …”

“…The frequent and early use of insulin in Sweden increased the possibility of finding well‐matched patients initiated on DPP‐4 inhibitors or SGLT2 inhibitor, for example, using caliper 0.2 when propensity score‐matching. The reason for the high use of insulin in Sweden compared with other European countries is not clearly understood, but an explanation could be the Swedish national guidelines that state treatment with medium‐ to long‐acting insulin is the highest priority after metformin in pharmacological treatment of T2D. Sensitivity analyses were performed to test the primary method of defining the novel and insulin groups and the results remained robust.…”

“…In contrast to insulin treatment, novel glucose‐lowering agents for the treatment of T2D, including SGLT2 inhibitors and DPP‐4 inhibitors, are alternative options with the advantages of oral administration, low risk of hypoglycaemia and weight gain and with recent proof of cardiovascular safety . Sweden has a relatively high use of insulin for the treatment of T2D compared with other European countries …”