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Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017

AIM: To describe population‐level time trends in prescribing patterns of type 2 diabetes therapy, and in short‐term clinical outcomes (glycated haemoglobin [HbA1c], weight, blood pressure, hypoglycaemia and treatment discontinuation) after initiating new therapy. MATERIALS AND METHODS: We studied 81...

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Autores principales: Dennis, John M., Henley, William E., McGovern, Andrew P., Farmer, Andrew J., Sattar, Naveed, Holman, Rury R., Pearson, Ewan R., Hattersley, Andrew T., Shields, Beverley M., Jones, Angus G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618851/
https://www.ncbi.nlm.nih.gov/pubmed/30828962
http://dx.doi.org/10.1111/dom.13687
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author Dennis, John M.
Henley, William E.
McGovern, Andrew P.
Farmer, Andrew J.
Sattar, Naveed
Holman, Rury R.
Pearson, Ewan R.
Hattersley, Andrew T.
Shields, Beverley M.
Jones, Angus G.
author_facet Dennis, John M.
Henley, William E.
McGovern, Andrew P.
Farmer, Andrew J.
Sattar, Naveed
Holman, Rury R.
Pearson, Ewan R.
Hattersley, Andrew T.
Shields, Beverley M.
Jones, Angus G.
author_sort Dennis, John M.
collection PubMed
description AIM: To describe population‐level time trends in prescribing patterns of type 2 diabetes therapy, and in short‐term clinical outcomes (glycated haemoglobin [HbA1c], weight, blood pressure, hypoglycaemia and treatment discontinuation) after initiating new therapy. MATERIALS AND METHODS: We studied 81 532 people with type 2 diabetes initiating a first‐ to fourth‐line drug in primary care between 2010 and 2017 inclusive in United Kingdom electronic health records (Clinical Practice Research Datalink). Trends in new prescriptions and subsequent 6‐ and 12‐month adjusted changes in glycaemic response (reduction in HbA1c), weight, blood pressure and rates of hypoglycaemia and treatment discontinuation were examined. RESULTS: Use of dipeptidyl peptidase‐4 inhibitors as second‐line therapy near doubled (41% of new prescriptions in 2017 vs. 22% in 2010), replacing sulphonylureas as the most common second‐line drug (29% in 2017 vs. 53% in 2010). Sodium‐glucose co‐transporter‐2 inhibitors, introduced in 2013, comprised 17% of new first‐ to fourth‐line prescriptions by 2017. First‐line use of metformin remained stable (91% of new prescriptions in 2017 vs. 91% in 2010). Over the study period there was little change in average glycaemic response and in the proportion of people discontinuing treatment. There was a modest reduction in weight after initiating second‐ and third‐line therapy (improvement in weight change 2017 vs. 2010 for second‐line therapy: −1.5 kg, 95% confidence interval [CI] −1.9, −1.1; P < 0.001), and a slight reduction in systolic blood pressure after initiating first‐, second‐ and third‐line therapy (improvement in systolic blood pressure change 2017 vs. 2010 range: −1.7 to −2.1 mmHg; all P < 0.001). Hypoglycaemia rates decreased over time with second‐line therapy (incidence rate ratio 0.94 per year, 95% CI 0.88, 1.00; P = 0.04), mirroring the decline in use of sulphonylureas. CONCLUSIONS: Recent changes in prescribing of therapy for people with type 2 diabetes have not led to a change in glycaemic response and have resulted in modest improvements in other population‐level short‐term clinical outcomes.
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spelling pubmed-66188512019-07-22 Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017 Dennis, John M. Henley, William E. McGovern, Andrew P. Farmer, Andrew J. Sattar, Naveed Holman, Rury R. Pearson, Ewan R. Hattersley, Andrew T. Shields, Beverley M. Jones, Angus G. Diabetes Obes Metab Original Articles AIM: To describe population‐level time trends in prescribing patterns of type 2 diabetes therapy, and in short‐term clinical outcomes (glycated haemoglobin [HbA1c], weight, blood pressure, hypoglycaemia and treatment discontinuation) after initiating new therapy. MATERIALS AND METHODS: We studied 81 532 people with type 2 diabetes initiating a first‐ to fourth‐line drug in primary care between 2010 and 2017 inclusive in United Kingdom electronic health records (Clinical Practice Research Datalink). Trends in new prescriptions and subsequent 6‐ and 12‐month adjusted changes in glycaemic response (reduction in HbA1c), weight, blood pressure and rates of hypoglycaemia and treatment discontinuation were examined. RESULTS: Use of dipeptidyl peptidase‐4 inhibitors as second‐line therapy near doubled (41% of new prescriptions in 2017 vs. 22% in 2010), replacing sulphonylureas as the most common second‐line drug (29% in 2017 vs. 53% in 2010). Sodium‐glucose co‐transporter‐2 inhibitors, introduced in 2013, comprised 17% of new first‐ to fourth‐line prescriptions by 2017. First‐line use of metformin remained stable (91% of new prescriptions in 2017 vs. 91% in 2010). Over the study period there was little change in average glycaemic response and in the proportion of people discontinuing treatment. There was a modest reduction in weight after initiating second‐ and third‐line therapy (improvement in weight change 2017 vs. 2010 for second‐line therapy: −1.5 kg, 95% confidence interval [CI] −1.9, −1.1; P < 0.001), and a slight reduction in systolic blood pressure after initiating first‐, second‐ and third‐line therapy (improvement in systolic blood pressure change 2017 vs. 2010 range: −1.7 to −2.1 mmHg; all P < 0.001). Hypoglycaemia rates decreased over time with second‐line therapy (incidence rate ratio 0.94 per year, 95% CI 0.88, 1.00; P = 0.04), mirroring the decline in use of sulphonylureas. CONCLUSIONS: Recent changes in prescribing of therapy for people with type 2 diabetes have not led to a change in glycaemic response and have resulted in modest improvements in other population‐level short‐term clinical outcomes. Blackwell Publishing Ltd 2019-04-04 2019-07 /pmc/articles/PMC6618851/ /pubmed/30828962 http://dx.doi.org/10.1111/dom.13687 Text en © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Dennis, John M.
Henley, William E.
McGovern, Andrew P.
Farmer, Andrew J.
Sattar, Naveed
Holman, Rury R.
Pearson, Ewan R.
Hattersley, Andrew T.
Shields, Beverley M.
Jones, Angus G.
Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title_full Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title_fullStr Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title_full_unstemmed Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title_short Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017
title_sort time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: a retrospective analysis of primary care data, 2010–2017
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618851/
https://www.ncbi.nlm.nih.gov/pubmed/30828962
http://dx.doi.org/10.1111/dom.13687
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