Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017

Abstract

Highlights• Medication utilization trends for type 2 diabetes have changed significantly over the years with a shift towards newer agents, and in line with prevailing treatment guidelines. • Metformin is currently the most commonly prescribed glucose-lowering agent, while the use of insulin has increased tremendously in our institution. Use of sulfonylureas decreased, but to a lesser extent than other studies. • Glycemic control has remained largely stable throughout the 11-year study period, but the rate of severe hypoglycemia has increased. AbstractBackground: Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore. Methods: We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex-and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA 1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia. Results: From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA 1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose. Conclusion: Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained *Co-first author

Trends in cardiovascular risk factors and treatment goals in patients with diabetes in Singapore-analysis of the SingHealth Diabetes Registry

“…We found that older adults had better glycaemic control, which is in line with findings from other studies [ 40 – 42 ]. Possible reasons could be that older patients may have better access to medical care, may be more motivated to receive care, are more adherent with medication use, and are easier to achieve individualized HbA1c target of ≤8% [ 41 , 43 ] The greater gain at glycaemic control rate among the young adults is most likely due to their low initial control rate, leaving more room for improvement as compared with old adults.…”

Trends in glycaemic control and drug use in males and females with type 2 diabetes: Results of the Australian National Diabetes Audit from 2013 to 2019

“…The exception to these changes is the use of metformin, which has remained the most frequently prescribed antihyperglycaemic agent across the years and is still recommended as first‐line treatment in adults following the initial diagnosis of diabetes 39 . Similar medication‐prescribing trends have been reported in international cohorts 10,12,40 . Given the recently reported end‐organ protection afforded by GLP‐1 receptor agonists and SGLT2 inhibitors, it is probable that their future use will further increase in alignment with new guideline recommendations 41 …”

Trends in Glucose-Lowering Drug Use, Glycemic Control, and Severe Hypoglycemia in Adults With Diabetes in Hong Kong, 2002–2016

“…International treatment guidelines have been updated to reflect individualization of glycemic targets, taking into consideration specific patient factors and risks of atherosclerotic cardiovascular disease and renal complications (5)(6)(7)(8). These changes in management approaches will influence prescribing patterns, which may affect glycemic control, hypoglycemia, and diabetes-related complications (9)(10)(11)(12).…”