Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010-2017.
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.
|ジャーナル名||Diabetes, obesity & metabolism|
|投稿者||Dennis, John M; Henley, William E; McGovern, Andrew P; Farmer, Andrew J; Sattar, Naveed; Holman, Rury R; Pearson, Ewan R; Hattersley, Andrew T; Shields, Beverley M; Jones, Angus G|
|組織名||Health Statistics Group, Institute of Health Research, University of Exeter;Medical School, Exeter, UK.;Institute of Biomedical and Clinical Science, Royal Devon and Exeter Hospital,;Exeter, UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK.;Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow,;UK.;Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism,;University of Oxford, Oxford, UK.;Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical;School, University of Dundee, Dundee, UK.|