| アブストラクト | AIM: To examine trends of second-line glucose-lowering therapies among patients with type 2 diabetes (T2D) initiating first-line metformin in the United States and the United Kingdom, overall and by subgroups of cardiovascular disease (CVD) and calendar time. METHODS: Using the US Optum Clinformatics and the UK Clinical Practice Research Datalink, we identified adults with T2D who initiated first-line metformin or sulphonylurea monotherapy, separately, from 2013 to 2019. Within both cohorts, we identified patterns of second-line medications through June 2021. We stratified patterns by CVD and calendar time to investigate the impact of rapidly evolving treatment guidelines. RESULTS: We identified 148 511 and 169 316 patients initiating treatment with metformin monotherapy in the United States and the United Kingdom, respectively. Throughout the study period, sulphonylureas and dipeptidyl peptidase-4 inhibitors were the most frequently initiated second-line medications in the United States (43.4% and 18.2%, respectively) and the United Kingdom (42.5% and 35.8%, respectively). After 2018, sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists were more commonly used as second-line agents in the United States and the United Kingdom, although these agents were not preferentially prescribed among patients with CVD. Initiation of first-line sulphonylureas was much less common, and most sulphonylurea initiators had metformin added as the second-line agent. CONCLUSIONS: This international cohort study shows that sulphonylureas remain the most common second-line medications prescribed following metformin in both the United States and the United Kingdom. Despite recommendations, the use of newer glucose-lowering therapies with cardiovascular benefits remains low. |
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| 投稿者 | Abrahami, Devin; D'Andrea, Elvira; Yin, Hui; Kim, Seoyoung C; Paik, Julie M; Wexler, Deborah; Azoulay, Laurent; Patorno, Elisabetta |
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| 組織名 | Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's;Hospital and Harvard Medical School, Boston, Massachusetts, USA.;Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Canada.;Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's;Hospital, Boston, Massachusetts, USA.;New England Geriatric Research Education and Clinical Center, VA Boston;Healthcare System, Boston, Massachusetts, USA.;Massachusetts General Hospital Diabetes Center and Harvard Medical School,;Boston, Massachusetts, USA.;Department of Epidemiology, Biostatistics, and Occupational Health, McGill;University, Montreal, Canada.;Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada. |
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