Time trends in prescribing of type 2 diabetes drugs, glycemic response and risk factors: a retrospective analysis of primary care data, 2010-2017
dc.contributor.author | Dennis, J | |
dc.contributor.author | Henley, W | |
dc.contributor.author | McGovern, A | |
dc.contributor.author | Farmer, A | |
dc.contributor.author | Sattar, N | |
dc.contributor.author | Holman, R | |
dc.contributor.author | Pearson, E | |
dc.contributor.author | Hattersley, A | |
dc.contributor.author | Shields, B | |
dc.contributor.author | Jones, A | |
dc.date.accessioned | 2019-03-04T09:22:06Z | |
dc.date.issued | 2019-03-03 | |
dc.description.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. 4 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. | en_GB |
dc.description.sponsorship | Medical Research Council (MRC) | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.description.sponsorship | Wellcome Trust | en_GB |
dc.identifier.citation | Published online 3 March 2019 | en_GB |
dc.identifier.doi | 10.1111/dom.13687 | |
dc.identifier.grantnumber | MR/N00633X/1 | en_GB |
dc.identifier.grantnumber | 098395/Z/12/Z | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/36202 | |
dc.language.iso | en | en_GB |
dc.publisher | Wiley | en_GB |
dc.rights | © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. | |
dc.title | Time trends in prescribing of type 2 diabetes drugs, glycemic response and risk factors: a retrospective analysis of primary care data, 2010-2017 | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-03-04T09:22:06Z | |
dc.identifier.issn | 1462-8902 | |
dc.description | This is the author accepted manuscript. The final version is available on open access from Wiley via the DOI in this record | en_GB |
dc.identifier.journal | Diabetes, Obesity and Metabolism | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2019-03-01 | |
exeter.funder | ::Medical Research Council (MRC) | en_GB |
exeter.funder | ::National Institute for Health Research (NIHR) | en_GB |
rioxxterms.version | AM | en_GB |
rioxxterms.licenseref.startdate | 2019-03-01 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-03-01T18:34:14Z | |
refterms.versionFCD | AM | |
refterms.dateFOA | 2019-04-03T09:01:48Z | |
refterms.panel | A | en_GB |
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This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.