Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD

Farmer, Ruth; Beard, Ivan; Raza, Syed; Gollop, Nicholas D.; Patel, N. R.; Tebboth, Abigail; McGovern, Andrew; Kanumilli, Naresh; Ternouth, Andrew

doi:10.1016/j.clinthera.2020.12.015

Cited by 34 publications

(46 citation statements)

References 33 publications

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“…The American Association of Clinical Endocrinologists/American College of Endocrinology 2019 consensus statement suggests that SGLT‐2 inhibitors and GLP‐1 RAs may be preferred as first‐line therapy in patients with recent‐onset T2D 23 . Despite the shown cardioprotective benefits of GLP‐1 RAs and SGLT‐2 inhibitors, overall usage in UK clinical practice remains low in adults with T2D and slightly lower in those with pre‐existing CVD history, based on data from the Clinical Practice Research Datalink 25 . Four oral treatment options (sulphonylureas, thiazolidinediones, SGLT‐2 inhibitors, or dipeptidyl peptidase‐4 [DPP‐4] inhibitors) are recommended by the American College of Physicians 26 …”

Section: Complexity and Divergence Of Guidelines May Represent A Barr...mentioning

confidence: 99%

Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

Khunti

Jabbour

Cos

et al. 2022

Diabetes Obesity Metabolism

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Recent advances in type 2 diabetes (T2D) research have highlighted the benefits of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, including cardiovascular and renal protection. However, uptake rates of these drugs remain low in patients with T2D, particularly in subpopulations most likely to benefit from them. This review considers the potential barriers to prescribing SGLT‐2 inhibitors in T2D in clinical practice and outlines potential multidisciplinary recommendations to overcome these barriers. Safety concerns and a lack of clarity in and divergence of guidelines around the introduction of SGLT‐2 inhibitors into treatment regimens may represent a barrier to uptake from the clinicians' perspective, including a general lack of understanding of the benefits associated with SGLT‐2 inhibitors. Patient characteristics, such as socioeconomic status, may influence uptake because of the cost of SGLT‐2 inhibitors, especially in the United States, where health insurance coverage could be a concern. SGLT‐2 inhibitor prescription rates vary between clinical specialty (endocrinology, primary care, cardiology, and nephrology) and country, with cardiologists the lowest prescribers, and endocrinologists the highest. Primary care practitioners may experience more challenges in following SGLT‐2 inhibitor‐related guidelines than diabetes specialists as there may be fewer opportunities for education on how this drug class improves cardiovascular and renal outcomes in patients with T2D. Uptake rates appear to vary between countries because of differences in guidelines and health insurance systems. The amendment of SGLT‐2 inhibitor‐related guidelines for more multidisciplinary use and the implementation of patient and clinician education may encourage uptake of these drugs, potentially improving long‐term health outcomes among patients with T2D.

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Section: Complexity and Divergence Of Guidelines May Represent A Barr...mentioning

confidence: 99%

Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

Khunti

Jabbour

Cos

et al. 2022

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Long-acting GLP-1 RAs include liraglutide (with a half-life of 13 h), exenatide OW (a prolonged-release formulation of the active drug from poly[D,L-lactide-co-glycolide] microspheres) and dulaglutide (with a half-life of 4.7 days) [21,22], and s.c. semaglutide formulation (with a half-life of 7 days) [6,29]. Over the last decade, although the prescription of GLP-1 RAs has increased slightly, overall usage remains low compared with other glucose-lowering medications, such as metformin, sulfonylureas and dipeptidyl peptidase 4 inhibitors (DPP4i), regardless of CV disease status [30][31][32][33]. A UK analysis described class-level prescribing of glucose-lowering medications in people with T2D and showed a small increase in the prescription of GLP-1 RA from 2017 to 2020 [30].…”

Section: Overview Of Available Glp-1 Ras In the Uk And Europementioning

confidence: 99%

“…Over the last decade, although the prescription of GLP-1 RAs has increased slightly, overall usage remains low compared with other glucose-lowering medications, such as metformin, sulfonylureas and dipeptidyl peptidase 4 inhibitors (DPP4i), regardless of CV disease status [30][31][32][33]. A UK analysis described class-level prescribing of glucose-lowering medications in people with T2D and showed a small increase in the prescription of GLP-1 RA from 2017 to 2020 [30]. The proportion of people treated with GLP-1 RA was approximately 6% for dual therapy and 17% for triple therapy in December 2019 [30].…”

Section: Overview Of Available Glp-1 Ras In the Uk And Europementioning

confidence: 99%

“…A UK analysis described class-level prescribing of glucose-lowering medications in people with T2D and showed a small increase in the prescription of GLP-1 RA from 2017 to 2020 [30]. The proportion of people treated with GLP-1 RA was approximately 6% for dual therapy and 17% for triple therapy in December 2019 [30]. Despite the CV benefits of some GLP-1 RAs [34][35][36][37][38], there was no difference in the prescribing rates of GLP-1 RAs between people with and without CV disease history [30].…”

Section: Overview Of Available Glp-1 Ras In the Uk And Europementioning

confidence: 99%

“…The proportion of people treated with GLP-1 RA was approximately 6% for dual therapy and 17% for triple therapy in December 2019 [30]. Despite the CV benefits of some GLP-1 RAs [34][35][36][37][38], there was no difference in the prescribing rates of GLP-1 RAs between people with and without CV disease history [30]. In a Danish nationwide cohort study in people with a new dual diagnosis of T2D and CV disease, the number of people prescribed a GLP-1 RA within a year of diagnosis increased from 3.9% in 2012 to 8.1% in 2018 [31].…”

Section: Overview Of Available Glp-1 Ras In the Uk And Europementioning

confidence: 99%

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Glucagon-Like Peptide 1 Receptor Agonist Usage in Type 2 Diabetes in Primary Care for the UK and Beyond: A Narrative Review

et al. 2021

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The scientific landscape of treatments for type 2 diabetes (T2D) has changed rapidly in the last decade with newer treatments becoming available. However, a large proportion of people with T2D are not able to achieve glycaemic goals because of clinical inertia. The majority of T2D management is in primary care, where clinicians (medical, nursing and pharmacist staff) play an important role in addressing patient needs and achieving treatment goals. However, management of T2D is challenging because of the heterogeneity of T2D and complexity of comorbidity, time constraints, guidance overload and the evolving treatments.

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Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014–2022)

Lin

Pearson

Greenfield

et al. 2023

Eur J Clin Pharmacol

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Purpose To investigate trends in SGLT2i and GLP-1RA use in Australia in the era of increased evidence of their cardiovascular benefits. Methods We used national dispensing claims for a 10% random sample of Australians to estimate the number of prevalent and new users (no dispensing in the prior year) of SGLT2i or GLP-1RA per month from January 2014 to July 2022. We assessed prescriber specialty and prior use of other antidiabetic and cardiovascular medicines as a proxy for evidence of type 2 diabetes (T2D) and cardiovascular conditions, respectively. Results We found a large increase in the number of prevalent users (216-fold for SGLT2i; 11-fold for GLP-1RA); in July 2022 approximately 250,000 Australians were dispensed SGLT2i and 120,000 GLP-1RA. Most new users of SGLT2i or GLP-1RA had evidence of both T2D and cardiovascular conditions, although from 2022 onwards, approximately one in five new users of SGLT2i did not have T2D. The proportion of new users initiating SGLT2i by cardiologists increased after 2021, reaching 10.0% of initiations in July 2022. Among new users with evidence of cardiovascular conditions, empagliflozin was the most commonly prescribed SGLT2i, while dulaglutide or semaglutide was the most common GLP-1RA. Conclusion SGLT2i and GLP-1RA use is increasing in Australia, particularly in populations with higher cardiovascular risk. The increased use of SGLT2i among people without evidence of T2D suggests that best-evidence medicines are adopted in Australia across specialties, aligning with new evidence and expanding indications.

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Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD

Cited by 34 publications

References 33 publications

Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

Glucagon-Like Peptide 1 Receptor Agonist Usage in Type 2 Diabetes in Primary Care for the UK and Beyond: A Narrative Review

Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014–2022)

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