Objective: Type 2 diabetes is a chronic condition that continues to increase in prevalence in the UK. Incretin-based therapies, including liraglutide and sitagliptin, provide adequate blood glucose control. Clinical trials have shown that liraglutide offers greater glycaemic control and body weight reduction in comparison to sitagliptin. We aimed to assess the effectiveness of liraglutide and sitagliptin in routine clinical practice. Materials and methods: We designed and conducted a retrospective database analysis in primary care using the Clinical Practice Research Datalink in the UK. Patients aged ≥ 18 years, diagnosed with type 2 diabetes and prescribed liraglutide or sitagliptin between July 2009 and July 2012, were included in the study. Glycaemic and weight control were investigated 6 months after treatment initiation. Results: A total of 287 liraglutide and 2781 sitagliptin patients were identified. Compared with sitagliptin, liraglutide recipients had greater reductions in HbA 1c (%) (À0.90 vs. À0.57, p < 0.01), weight (kg) (À3.78 vs. À1.12, p < 0.001), BMI (kg/m 2 ) (À1.30 vs. À0.39, p < 0.001) and systolic blood pressure (mmHg) (À3.91 vs. À0.39, p < 0.001) after 6 months of treatment. When controlling for potential confounders, liraglutide was more likely than sitagliptin to achieve an HbA 1c reduction ≥ 1% (OR = 2.29, 95% CI 1.62-3.25), an HbA 1c reduction ≥ 1% and a weight reduction ≥ 3% (OR = 2.99; 95% CI 2.00-4.48) and a target HbA 1c < 7% (OR = 2.11; 95% CI 1.45-3.07) after 6 months of treatment. Conclusions: Clinical trials show superior glycaemic control and weight reduction with liraglutide compared with sitagliptin. This finding is reflected in routine clinical practice in the UK. What's knownResults from randomised clinical trials have demonstrated superior reductions in glycosylated haemoglobin (HbA 1c ) and body weight in type 2 diabetes patients receiving liraglutide compared with sitagliptin. However, the effectiveness of liraglutide and sitagliptin has not been widely assessed in routine clinical practice in the UK.

The aim of this study was to estimate the annual number of days absent from work associated with diabetes-related complications. Registry data were obtained for 34,882 individuals aged 18–70 years with hospital-diagnosed diabetes (ICD-10 codes: E10–E14) identified from a large national sample (40% of the Danish population) with 6 years of hospital utilisation data. The occurrence of a complication was defined as a hospital admission with a specified diagnosis or procedure code. Data on sickness episodes with municipal subsidy were retrieved for each individual. Days absent from work attributable to complications were defined as the estimated difference in absence days between individuals with and without the specified complication and were estimated for the first and subsequent years after the initial episode of the recorded complication. Angina pectoris, ischaemic stroke, and heart failure were the three most frequent complications in the population. Heart failure, amputation, renal disease, and peripheral vascular disease were on average associated with more than three-month additional absence from work during the first and subsequent years. Leg ulcers and neuropathy were associated with more days absent from work during the first year than in subsequent years. Diabetes complications are associated with a substantial number of additional days absent from work. The avoidance of these complications would benefit both patients and society.

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Background: Weight gain can contribute towards the development of type 2 diabetes (T2D), and some treatments for T2D can lead to weight gain. The aim of this study was to determine whether having T2D and also being obese had a greater or lesser impact on health-related quality of life (HRQoL) than having either of the two conditions alone. Methods: The 2003 dataset of the Health Survey for England (HSE) was analyzed using multiple regression analyses to examine the influence of obesity and T2D on HRQoL, and to determine whether there was any interaction between these two disutilities. Results: T2D reduced HRQoL by 0.029 points, and obesity reduced HRQoL by 0.027 points. There was no significant interaction effect between T2D and obesity, suggesting that the effect of having both T2D and being obese is simply additive and results in a reduction in HRQoL of 0.056. Conclusions: Based on analysis of HSE 2003 data, people with either T2D or obesity experience significant reduction in HRQoL and people with both conditions have a reduction in HRQoL equal to the sum of the two independent effects. The effect of obesity on HRQoL in people with T2D should be considered when selecting a therapy.

BackgroundHeart failure (HF) imposes a large burden on both the individual and the society. The aim of this study was to investigate the economic burden (either direct or indirect costs) attributed to patients with HF before, at, and after time of diagnosis.Methods and resultsUsing Danish nationwide registries we identified all patients > 18 years with a first‐time diagnosis of HF from 1998–2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF. A total of 176 067 HF patients with a median age of 76 (interquartile range 67–84) years and 55% male were included. Patients with HF incurred an average of €17 039 in total annual direct (€11 926) and indirect (€5113) healthcare costs peaking at year of diagnosis compared to €5936 in the control group with the majority attributable to inpatient admissions. The total annual net costs including public transfer after index HF were €11 957 higher in patients with HF compared to controls and the economic consequences were evident more than 2 years prior to the diagnosis of HF.ConclusionPatients with HF impose significantly higher total annual healthcare costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis.