Michelle Greiver1, Alys Havard2, Juliana Kf Bowles3, Sumeet Kalia4, Tao Chen5, Babak Aliarzadeh4, Rahim Moineddin4, Julian Sherlock6, William Hinton6, Frank Sullivan7, Braden O'Neill1, Conrad Pow5, Aashka Bhatt4, Fahurrozi Rahman3, Bernardo Meza-Torres6, Melisa Litchfield2, Simon de Lusignan8. 1. Department of Family and Community Medicine, North York General Hospital, Toronto, Canada and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada. 2. Centre for Big Data Research in Health, University of New South Wales Sydney, Sydney, Australia. 3. School of Computer Science, University of St Andrews, St Andrews, UK. 4. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada. 5. Department of Family and Community Medicine, North York General Hospital, Toronto, Canada, and Diabetes Action Canada, Toronto, Canada. 6. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, and Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK. 7. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada, and School of Medicine, University of St Andrews, St Andrews, UK. 8. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; director, Royal College of General Practitioners Research and Surveillance Centre, London, UK.
Abstract
BACKGROUND: Several new classes of glucose-lowering medications have been introduced in the past two decades. Some, such as sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake in order to find ways to support the use of more effective treatments. AIM: To analyse the uptake of these new classes among patients with type 2 diabetes. DESIGN AND SETTING: This was a retrospective repeated cross-sectional analysis in primary care. Rates of medication uptake in Australia, Canada, England, and Scotland were compared. METHOD: Primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017 were used. Individuals aged ≥40 years on at least one glucose-lowering drug class in each year of interest were included, excluding those on insulin only. Proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes were determined. RESULTS: Data from 238 619 patients were included in 2017. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017, more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). CONCLUSION: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.
BACKGROUND: Several new classes of glucose-lowering medications have been introduced in the past two decades. Some, such as sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake in order to find ways to support the use of more effective treatments. AIM: To analyse the uptake of these new classes among patients with type 2 diabetes. DESIGN AND SETTING: This was a retrospective repeated cross-sectional analysis in primary care. Rates of medication uptake in Australia, Canada, England, and Scotland were compared. METHOD: Primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017 were used. Individuals aged ≥40 years on at least one glucose-lowering drug class in each year of interest were included, excluding those on insulin only. Proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes were determined. RESULTS: Data from 238 619 patients were included in 2017. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017, more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). CONCLUSION: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.
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