Trends in First-Line Glucose-Lowering Drug Use in Adults With Type 2 Diabetes in Light of Emerging Evidence for SGLT-2i and GLP-1RA.

Abstract

OBJECTIVE:

We evaluated recent use trends and predictors of first-line antidiabetes treatment in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

Using two large U.S. health insurance databases (Clinformatics and Medicare), we identified adult patients with type 2 diabetes who initiated antidiabetes treatment from 2013 through 2019. Quarterly trends in use of first-line antidiabetes treatment were plotted overall and stratified by cardiovascular disease (CVD). Multinomial logistic regressions were fit to estimate predictors of first-line antidiabetes treatment, using metformin, the recommended first-line treatment for type 2 diabetes, as the common referent.

RESULTS:

Metformin was the most frequently initiated medication, used by 80.6% of Medicare beneficiaries and 83.1% of commercially insured patients. Sulfonylureas were used by 8.7% (Medicare) and 4.7% (commercial). Both populations had low use of sodium-glucose cotransporter 2 inhibitors (SGLT-2i, 0.8% [Medicare] and 1.7% [commercial]) and glucagon-like peptide 1 receptor agonists (GLP-1Ra; 1.0% [Medicare] and 3.5% [commercial]), with increasing trends over time (P < 0.01). Initiators of antidiabetes drugs with established cardiovascular benefits (SGLT-2i and GLP-1RA) were more likely to be younger and had prevalent CVD or higher socioeconomic status compared with initiators of metformin.

CONCLUSIONS:

Among adult patients with type 2 diabetes, metformin was by far the most frequent first-line treatment. While the use of SGLT-2i and GLP-1RA was low from 2013 through 2019, it increased among patients with CVD.

• Authors: HoJin Shin, Sebastian Schneeweiss, Robert J Glynn, Elisabetta Patorno
• Journal: Diabetes care (Diabetes Care) Vol. 44 Issue 8 Pg. 1774-1782 (08 2021) ISSN: 1935-5548 [Electronic] United States
• PMID: 34385345 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 by the American Diabetes Association.

Chemical References

• Glucagon-Like Peptide-1 Receptor
• Hypoglycemic Agents
• Pharmaceutical Preparations
• Sodium-Glucose Transporter 2 Inhibitors
• Glucose

Topics

• Adult
• Aged
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology)
• Glucagon-Like Peptide-1 Receptor
• Glucose
• Humans
• Hypoglycemic Agents (therapeutic use)
• Medicare
• Pharmaceutical Preparations
• Sodium-Glucose Transporter 2 Inhibitors
• United States (epidemiology)