Time trends in prescribing of type 2 diabetes drugs, glycemic response and risk factors: a retrospective analysis of primary care data, 2010-2017.
AIM: Prescribing in type 2 diabetes has changed markedly in recent years, with increasing use of newer, more expensive glucose-lowering drugs. We aimed to describe population-level time trends in both prescribing patterns and short-term patient outcomes (HbA1c, weight, blood pressure, hypoglycemia and treatment discontinuation) after initiating new therapy.
MATERIALS AND METHODS: We studied 81,532 UK patients with type 2 diabetes initiating a first to fourth line drug in primary care between 2010-2017 inclusive (Clinical Practice Research Datalink). Trends in new prescriptions and subsequent six and twelve-month adjusted changes in glycemic response (reduction in HbA1c), weight, blood pressure, and rates of hypoglycemia and treatment discontinuation were examined.
RESULTS: DPP4-inhibitor use second-line near doubled (41% of new prescriptions in 2017 vs. 22% 2010), replacing sulfonylureas as the most common second-line drug (29% 2017 vs. 53% 2010). SGLT2-inhibitors, introduced in 2013, comprised 17% of new first-fourth line prescriptions by 2017. First-line use of metformin remained stable (91% of new prescriptions in 2017 vs. 91% 2010). Over the study period there was little change in average glycemic response and treatment discontinuation. There was a modest reduction in weight second and third-line (second line 2017 vs. 2010: -1.5 kg (95%CI -1.9;-1.1), p<0.001), and a slight reduction in systolic blood pressure first to third-line (2017 vs. 2010 difference range -1.7 to -2.1 mmHg, all p<0.001). Hypoglycemia rates decreased second-line (incidence rate ratio 0.94 per-year (95%CI 0.88;1.00, p=0.04)), mirroring the decline in use of sulfonylureas.
CONCLUSIONS: Recent changes in prescribing of therapy in type 2 diabetes have not led to a change in glycemic response and have resulted in modest improvements in other population-level short-term patient outcomes. This article is protected by copyright. All rights reserved.
|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 & Clinical Science, RILD Building, Royal Devon & Exeter;Hospital, Barrack Road, Exeter, UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK.;University of Glasgow. Address: Institute of Cardiovascular and Medical Sciences,;University of Glasgow, Glasgow G12 8TA, UK.;Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism,;University of Oxford. Oxford NIHR Biomedical Research Centre, Churchill Hospital,;Oxford. Address: Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology;and Metabolism, University of Oxford, Oxford, UK.;Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School,;University of Dundee, Dundee, UK.;University of Exeter Medical School. Institute of Biomedical & Clinical Science,;RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK.|