Have shifts in glucose-lowering drug prescribing made a difference?

  • Dennis JM & al.
  • Diabetes Obes Metab
  • 3 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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 design

  • 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).

Key results

  • 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).

Limitations

  • Study limited to UK population.
  • Macrovascular/microvascular outcomes not evaluated.

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