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Diabetes Obes Metab. 2019 Mar 3. doi: 10.1111/dom.13687. [Epub ahead of print]

Time trends in prescribing of type 2 diabetes drugs, glycemic response and risk factors: a retrospective analysis of primary care data, 2010-2017.

Author information

1
Health Statistics Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK.
2
Institute of Biomedical & Clinical Science, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK.
3
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
4
University of Glasgow. Address: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
5
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.
6
Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
7
University of Exeter Medical School. Institute of Biomedical & Clinical Science, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK.

Abstract

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.

PMID:
30828962
DOI:
10.1111/dom.13687

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