![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
Abstract
Purpose
To understand the patient characteristics associated with treatment choice at the first treatment intensification for type 2 diabetes.
Patients and methods
This is a noninterventional study, using UK electronic primary care records from the Clinical Practice Research Datalink. We included adults treated with metformin monotherapy between January 2000 and July 2017. The outcome of interest was the drug prescribed at first intensification between 2014 and 2017. We used multinomial logistic regression to calculate the ORs for associations between the drugs and patient characteristics.
Results
In total, 14,146 people started treatment with an intensification drug. Younger people were substantially more likely to be prescribed sodium-glucose co-transporter-2 inhibitors (SGLT2is), than sulfonylureas (SUs): OR for SGLT2i prescription for those aged <30 years was 2.47 (95% CI 1.39–4.39) compared with those aged 60–70 years. Both overweight and obesity were associated with greater odds of being prescribed dipeptidyl peptidase-4 inhibitor (DPP4i) or SGLT2i. People of non-white ethnicity were less likely to be prescribed SGLT2i or DPP4i: compared with white patients, the OR of being prescribed SGLT2i among South Asians is 0.60 (95% CI 0.42–0.85), and for black people, the OR is 0.54 (95% CI 0.30–0.97). Lower socioeconomic status was also independently associated with reduced odds of being prescribed SGLT2is.
Conclusion
Both clinical and demographic factors are associated with prescribing at the first stage of treatment intensification, with older and non-white people less likely to receive new antidiabetic treatments. Our results suggest that the selection of treatment options used at the first stage of treatment intensification for type 2 diabetes is not driven by clinical need alone.
Acknowledgments
This study was supported by GlaxoSmithKline (GSK), through a PhD scholarship for SW. LAT is funded by a Well-come Trust intermediate clinical fellowship (101143/Z/13/Z). HS-F is a full-time employee of GSK. IJD is paid by an unrestricted grant from GSK.
Disclosure
SW is funded by a GSK PhD scholarship. HAS-F is an employee of and holds shares in GSK. IJD is funded by, holds stock in and has consulted for GSK. DF has consulted for clinical trial adjudication associated with oral hypoglycemia medications (ACI clinical), and consulted for Boehringer-Ingelheim. AP reports personal fees from NovoNordisk, Boehringer Ingleheim, and Eli Lilly outside of the submitted work. LS has received grants from GSK and has received grants from the Wellcome Trust, the the Medical Research Council, the National Institute for Health Research, the British Heart Foundation, and Diabetes UK outside of the submitted work and is a Trustee of the British Heart Foundation. LAT and EW have no relevant conflicts of interest to disclose in this work.
Author contributions
SW, LAT, IJD, HAS-F, EW, and LS conceived and devised the study, and SW analyzed the data. All authors contributed to the interpretation of the data. SW drafted the article and all authors (SW, IJD, EW, HAS-F, DF, AP, LS, LAT) reviewed and edited the manuscript, and approved the version to be published, and agree to be accountable for all aspects of the work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. LAT accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.