National ambulatory care non-insulin antidiabetic medication prescribing trends in the United States from 2009 to 2015

Abstract

Objective Despite their efficacy in lowering hemoglobin A1c, recent data suggest that sulfonylureas are associated with cardiovascular risk and hypoglycemia. The objective of this study was to determine whether prescribers decreased sulfonylurea use in favor of newer medications in the United States over seven years. Research design and methods This cross-sectional study utilized data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey. Patient visits between 2009 and 2015 were included for patients who were at least 18 years old, had a documented prescription for a non-insulin antidiabetic medication, and a diagnosis of type 2 diabetes. Sample survey data were extrapolated to national estimates using data weights. Prescribing rates were calculated as the number of visits with a documented medication class divided by the total number of visits with a prescription for any diabetes medication class, times 100%. Results A total of 303 million patient visits were included in this study. The median (IQR) patient age was 64 (55–73) years old and 49.8% were male. Sulfonylurea prescribing rates decreased from 43% in 2009 to 36.5% in 2015. Prescribing of GLP-1 receptor agonists increased from 2009 to 2014 (3.95% to 5.30%), but then decreased to 4.19% in 2015. SGLT-2 inhibitor prescribing began in 2013 and increased to 7.3% by 2015. Metformin prescribing remained relatively stable over the study period (range 70% to 72%). Conclusions National ambulatory sulfonylurea prescribing decreased from 2009 to 2015 with a corresponding increase in newer non-insulin antidiabetic agent prescribing.

Prescription trends and costs of diabetes medications in Australia between 2003 and 2019: an analysis and review of the literature

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“…They observed a rapidly changing pattern over time (with sodium‐glucose co‐transporter‐2 inhibitors [SGLT‐2i] progressively increasing) and a significant geographical variation in England; the latter finding clearly underlines the utility of RWD because it demonstrates that decisions may be based on criteria beyond those addressed in guideline recommendations. A similar study in the US combined data from the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey (NAMCS) to assess prescription rates of glucose‐lowering medications in around 300 million clinical visits between 2009 and 2015 . Although there are some differences in the process of data collection between the two databases (routine administrative health record data in CPRD; probability‐sampled survey for NAMCS), the Authors reported a pattern similar to that observed in the United Kingdom, with decreasing trends in sulphonylureas utilization and a progressive increase in SGLT‐2i prescriptions.…”

Effects of dipeptidyl peptidase‐4 inhibitors and sulphonylureas on cognitive and physical function in nursing home residents

“…Data from the US Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey suggested that only a modest decrease in sulphonylurea use occurred between 2009 and 2015, and sulphonylureas were still prescribed in 39% of patients with T2DM aged ≥65 in 2015. 49 Additional recent studies have documented sulphonylurea prescriptions in 25% and 23% of NH residents with T2DM in Germany and Canada, respectively. 50,51 Evolving treatment guidelines have also emphasized the use of higher haemoglobin A1c targets for older adults in recent years.…”