Aims/hypothesis In recent years, several new medications for the treatment of type 2 diabetes have been released and some evidence indicates sociodemographic disparity in their utilisation. We sought to investigate sociodemographic disparities in receipt of diabetes medications across Australia. Methods This study included 1,203,317 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2007 to 2015. The NDSS was linked to the Australian pharmaceutical claims database. We investigated trends in diabetes medication dispensing and variation in dispensing by sociodemographic strata. Results Compared with individuals in the least disadvantaged areas, those in the most disadvantaged quintile were less likely to receive dipeptidyl peptidase-4 inhibitors (DPP4is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) in the first year of availability (OR [95% CI] for most vs least disadvantaged: 0.78 [0.75, 0.82], 0.65 [0.60, 0.71] and 0.89 [0.84, 0.95], respectively). These disparities dissipated over time for DPP4is and SGLT2is but remained significant for GLP-1RAs. The OR (95% CI) of receiving DPP4is, GLP-1RAs and SGLT2is in the first year of availability for people in remote areas vs major cities was 0.46 (0.39, 0.54), 0.46 (0.35, 0.61) and 0.71 (0.59, 0.84), respectively. These disparities remained significant through to 2015. Conclusions/interpretation People with diabetes in more disadvantaged areas are less likely to receive newer diabetes medications, although this effect decreased over time. However, there are considerable and persistent differences in receipt of newer diabetes medications between major cities and remote areas of Australia.

OBJECTIVE To determine trends in the incidence of major diabetes-related complications in Australia. RESEARCH DESIGN AND METHODS This study included 70,885 people with type 1 and 1,089,270 people with type 2 diabetes registered on the Australian diabetes registry followed from July 2010 to June 2019. Outcomes (hospitalization for myocardial infarction [MI], stroke, heart failure [HF], lower-extremity amputation [LEA], hypoglycemia, and hyperglycemia) were obtained via linkage to hospital admissions databases. Trends over time in the age-adjusted incidence of hospitalizations were analyzed using joinpoint regression and summarized as annual percent changes (APCs). RESULTS In type 1 diabetes, the incidence of all complications remained stable, except for stroke, which increased from 2010–2011 to 2018–2019 (financial years; APC: +2.5% [95% CI 0.1, 4.8]), and hyperglycemia, which increased from 2010–2011 to 2016–2017 (APC: +2.7% [1.0, 4.5]). In type 2 diabetes, the incidence of stroke remained stable, while the incidence of MI decreased from 2012–2013 to 2018–2019 (APC: −1.7% [95% CI −2.8, −0.5]), as did the incidence of HF and hypoglycemia from 2010–2011 to 2018–2019 (APCs: −0.8% [−1.5, 0.0] and −5.3% [−6.7, −3.9], respectively); the incidence of LEA and hyperglycemia increased (APCs: +3.1% [1.9, 4.4], and +7.4% [5.9, 9.0]). Most trends were consistent by sex, but differed by age; in type 2 diabetes most improvements were confined to individuals aged ≥60 years. CONCLUSIONS Trends in admissions for diabetes-related complications were largely stable in type 1 diabetes. In type 2 diabetes, hospitalization rates for MI, HF, and hypoglycemia fell over time, while increasing for LEA and hyperglycemia.

The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. RESEARCH DESIGN AND METHODSThis study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. RESULTSBetween 2002 and 2013, there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow-up. In the first 10-15 years following the onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes, the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes at ages 10-29 and 30-39 years, respectively. When death from ESKD without renal replacement therapy was included, the incidence of ESKD remained higher in older-onset diabetes for the initial 20 years, with no clear effect of age thereafter. CONCLUSIONSThe long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger onset of diabetes because they are more likely to survive to longer diabetes durations.One of the most burdensome and costly complications of diabetes is end-stage kidney disease (ESKD) (1,2). People with diabetes are at considerably increased risk for the development of ESKD (3), and diabetic nephropathy (DN) is now the leading cause of ESKD, accounting for one-third of incident cases worldwide (4). Despite this significant burden, estimates of the long-term risk of ESKD for those with type 2 diabetes are scarce.