- The recent shift toward prescribing newer, more expensive, glucose-lowering medication for type 2 diabetes (T2D) may be reducing hypoglycemia, weight, and blood pressure, but does not appear to be improving glycemic control.
Why this matters
- Guidelines leave second-line agent choice (after metformin) to clinicians and patients.
- Study of 81,532 individuals with T2D initiating first- to fourth-line glucose-lowering drug prescriptions in UK primary care during 2010-2017.
- Funding: Medical Research Council (UK).
- In 2010 vs 2017, first-line metformin use was 91% at both time points.
- Second-line sulfonylurea prescribing decreased from 53% to 29%, while prescribing of dipeptidyl peptidase-4 inhibitors rose from 22% to 41%.
- Second-line sodium-glucose cotransporter 2 inhibitor prescribing rose to 19% following 2013 approval.
- No HbA1c improvement after second-line therapy (0.0% change; P=.80).
- Weight loss trend seen at 6 months overall, primarily with second- and third-line therapy (2017 vs 2010: −1.5 and −1.2 kg, respectively; both P<.001>
- Trend in BP reduction at 6 months (2017 vs 2010: range −1.7 to −2.1 mmHg; all P<.001 change in diastolic bp.>
- Hypoglycemia reduction seen with second-line therapy initiation (5.7 vs 8.2/1000 person-years for 2017 vs 2010, respectively).
- Study limited to UK population.
- Macrovascular/microvascular outcomes not evaluated.