Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017

Abstract

Aim To describe population‐level time trends in prescribing patterns of type 2 diabetes therapy, and in short‐term clinical outcomes (glycated haemoglobin [HbA1c], weight, blood pressure, hypoglycaemia and treatment discontinuation) after initiating new therapy. Materials and methods We studied 81 532 people with type 2 diabetes initiating a first‐ to fourth‐line drug in primary care between 2010 and 2017 inclusive in United Kingdom electronic health records (Clinical Practice Research Datalink). Trends in new prescriptions and subsequent 6‐ and 12‐month adjusted changes in glycaemic response (reduction in HbA1c), weight, blood pressure and rates of hypoglycaemia and treatment discontinuation were examined. Results Use of dipeptidyl peptidase‐4 inhibitors as second‐line therapy near doubled (41% of new prescriptions in 2017 vs. 22% in 2010), replacing sulphonylureas as the most common second‐line drug (29% in 2017 vs. 53% in 2010). Sodium‐glucose co‐transporter‐2 inhibitors, introduced in 2013, comprised 17% of new first‐ to fourth‐line prescriptions by 2017. First‐line use of metformin remained stable (91% of new prescriptions in 2017 vs. 91% in 2010). Over the study period there was little change in average glycaemic response and in the proportion of people discontinuing treatment. There was a modest reduction in weight after initiating second‐ and third‐line therapy (improvement in weight change 2017 vs. 2010 for second‐line therapy: −1.5 kg, 95% confidence interval [CI] −1.9, −1.1; P < 0.001), and a slight reduction in systolic blood pressure after initiating first‐, second‐ and third‐line therapy (improvement in systolic blood pressure change 2017 vs. 2010 range: −1.7 to −2.1 mmHg; all P < 0.001). Hypoglycaemia rates decreased over time with second‐line therapy (incidence rate ratio 0.94 per year, 95% CI 0.88, 1.00; P = 0.04), mirroring the decline in use of sulphonylureas. Conclusions Recent changes in prescribing of therapy for people with type 2 diabetes have not led to a change in glycaemic response and have resulted in modest improvements in other population‐level short‐term clinical outcomes.

Real-World Evidence for Long-Term Safety and Effectiveness of Ipragliflozin in Japanese Patients with Type 2 Diabetes Mellitus: final Results of a 3-Year Post-Marketing Surveillance Study (STELLA-LONG TERM)

“…Based on the results of these key trials, the European Society of Cardiology and the European Association for the Study of Diabetes recommend SGLT2 inhibitors as first-line oral medication for specific T2DM patients, such as those with high-risk or established cardiovascular disease and chronic kidney disease [6]. Accordingly, the use of SGLT2 inhibitors has been rapidly increasing both globally [7], as well as in Japan [8].…”

Risk factors for genital infections in people initiating SGLT2 inhibitors and their impact on discontinuation

“…Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are an increasingly important oral medication class in type 2 diabetes [1][2][3] with their use climbing dramatically in recent years. [4][5][6][7] They result in a broadly similar amount of glucose lowering compared with other oral agents but can also reduce blood pressure and result in modest weight loss. [8][9][10] In addition to their glucose lowering effects, large-scale clinical trials have demonstrated reduction in cardiovascular and renal outcomes in highrisk groups with type 2 diabetes, [11][12][13] as well as benefit in patients with heart failure whether or not they have type 2 diabetes.…”

Prevalence of Albuminuria in Cardiology and Endocrinology Departments and Its Influencing Factors: A Multicenter, Real-World Evidence Study in China

“…Recently, new evidences suggest that SGLT2 inhibitors and GLP-1 agonists have renoprotective effects [19]. And by 2017, SGLT2 inhibitors and GLP-1 agonists had comprised 17% and 11% of new firstto fourth-line prescriptions [20]. So, the prevalence of albuminuria may change in the next decade.…”