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

Dennis, J. M., Henley, W. E., McGovern, A. P., Farmer, A. J., Sattar, N. , Holman, R. R., Pearson, E. R., Hattersley, A. T., Shields, B. M. and Jones, A. G. (2019) Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: a retrospective analysis of primary care data, 2010–2017. Diabetes, Obesity and Metabolism, 21(7), pp. 1576-1584. (doi: 10.1111/dom.13687) (PMID:30828962) (PMCID:PMC6618851)

Abstract

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.

• Item Type: Articles
• Additional Information: A.T.H. and R.H.H. are National Institute of Health Research (NIHR) Senior Investigators. A.T.H. is a Wellcome Trust Senior Investigator (098395/Z/12/Z). A.G.J. is supported by an NIHR Clinician Scientist award (CS-2015-15-018). E.R.P. is a Wellcome Trust New Investigator (102820/Z/13/Z). A.T.H., B.M.S., A.P.M. and J.M.D. are supported by the NIHR Exeter Clinical Research Facility.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed
• Authors: Dennis, J. M., Henley, W. E., McGovern, A. P., Farmer, A. J., Sattar, N., Holman, R. R., Pearson, E. R., Hattersley, A. T., Shields, B. M., and Jones, A. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Diabetes, Obesity and Metabolism
• Publisher: Wiley
• ISSN: 1462-8902
• ISSN (Online): 1463-1326
• Published Online: 03 March 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Diabetes, Obesity and Metabolism 21(7): 1576-1584
• Publisher Policy: Reproduced under a Creative Commons License