Contemporary trends in the utilization of second-line pharmacological therapies for type 2 diabetes in the United States and the United Kingdom.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883645 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1326 (Electronic) Linking ISSN: 14628902 NLM ISO Abbreviation: Diabetes Obes Metab Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell, c1999-
    • Subject Terms:
      Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/epidemiology ; Diabetes Mellitus, Type 2*/chemically induced ; Metformin* ; Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Cardiovascular Diseases*/chemically induced; Adult ; Humans ; United States/epidemiology ; Hypoglycemic Agents/adverse effects ; Cohort Studies ; Sulfonylurea Compounds/adverse effects ; United Kingdom/epidemiology ; Glucose/therapeutic use
    • Abstract:
      Aim: To examine trends of second-line glucose-lowering therapies among patients with type 2 diabetes (T2D) initiating first-line metformin in the United States and the United Kingdom, overall and by subgroups of cardiovascular disease (CVD) and calendar time.
      Methods: Using the US Optum Clinformatics and the UK Clinical Practice Research Datalink, we identified adults with T2D who initiated first-line metformin or sulphonylurea monotherapy, separately, from 2013 to 2019. Within both cohorts, we identified patterns of second-line medications through June 2021. We stratified patterns by CVD and calendar time to investigate the impact of rapidly evolving treatment guidelines.
      Results: We identified 148 511 and 169 316 patients initiating treatment with metformin monotherapy in the United States and the United Kingdom, respectively. Throughout the study period, sulphonylureas and dipeptidyl peptidase-4 inhibitors were the most frequently initiated second-line medications in the United States (43.4% and 18.2%, respectively) and the United Kingdom (42.5% and 35.8%, respectively). After 2018, sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists were more commonly used as second-line agents in the United States and the United Kingdom, although these agents were not preferentially prescribed among patients with CVD. Initiation of first-line sulphonylureas was much less common, and most sulphonylurea initiators had metformin added as the second-line agent.
      Conclusions: This international cohort study shows that sulphonylureas remain the most common second-line medications prescribed following metformin in both the United States and the United Kingdom. Despite recommendations, the use of newer glucose-lowering therapies with cardiovascular benefits remains low.
      (© 2023 John Wiley & Sons Ltd.)
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    • Grant Information:
      K08 AG055670 United States AG NIA NIH HHS; U01 FD007213 United States FD FDA HHS
    • Contributed Indexing:
      Keywords: cardiovascular disease; cohort study; drug utilization; glucose-lowering medications; pharmacoepidemiology; type 2 diabetes
    • Accession Number:
      0 (Hypoglycemic Agents)
      9100L32L2N (Metformin)
      0 (Sulfonylurea Compounds)
      0 (Dipeptidyl-Peptidase IV Inhibitors)
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      IY9XDZ35W2 (Glucose)
    • Publication Date:
      Date Created: 20230703 Date Completed: 20230905 Latest Revision: 20240210
    • Publication Date:
      20240210
    • Accession Number:
      PMC10527897
    • Accession Number:
      10.1111/dom.15196
    • Accession Number:
      37395339