Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

Trends in diabetes medications in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1421 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Sumeet Kalia

Keyword(s):

Medical Data ◽

New Drugs ◽

Cross Sectional ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Sodium Glucose Cotransporter ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Sectional Analysis ◽

Dispensing Data

BackgroundWe studied the uptake of new classes of glucose lowering medications, such as Dipeptidyl peptidase-4 inhibitors (DPP4s) and Sodium-glucose cotransporter 2 inhibitors (SGLT2s) amongst patients living with type 2 diabetes. We compared this in Australia, Canada, England and Scotland, and explored whether these new drugs are supplementing or replacing older classes of medications. Research Design and MethodsWe used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose lowering medication in each year of interest; we excluded those on insulin only. We determined proportions of patients in each nation on each class of medication, as well as on combinations of classes. ResultsIn 2017, data from 28,063 patients in Canada, 106,000 in Australia, 88,953 in England and 15,603 in Scotland were included. The proportion of patients on metformin increased by 3.4% in Australia (95% CI: 3.24% to 3.55%) and decreased in the other nations. Canada had the greatest decrease, at 4.7% (95% CI: -5.05% to -4.34%). Sulfonylurea use decreased in most nations, while DPP4s increased in all. By 2017, between 10.1% and 15.3% of patients were on a SGLT2 and the use of either a DPP4 or SGLT2 combined with metformin approached or exceeded the use of sulfonylureas with metformin. ConclusionsNewer, more expensive medications are replacing sulfonylureas and, to a lesser degree, metformin. The effects of these trends on health outcomes and overall costs should be examined.

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Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

10.2337/figshare.13574600.v1 ◽

2021 ◽

Author(s):

Hui Shao ◽

Michael Laxy ◽

Stephen R. Benoit ◽

Yiling J. Cheng ◽

Edward W. Gregg ◽

...

Keyword(s):

Decomposition Analysis ◽

Fee For Service ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Drug Classes ◽

Out Of Pocket Payments ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Main Driver ◽

Glucagon Like Peptide 1 ◽

Total Payment

Objective To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018. Methods We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. Results Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase. Conclusion Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver.

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Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

10.2337/figshare.12970958 ◽

2020 ◽

Author(s):

Aimin Yang ◽

Hongjiang Wu ◽

Eric S.H. Lau ◽

Ronald C.W. Ma ◽

Alice P.S. Kong ◽

...

Keyword(s):

Hong Kong ◽

Glycemic Control ◽

Severe Hypoglycemia ◽

Population Based ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Patients With Diabetes ◽

Lowering Drug ◽

Design And Methods

OBJECTIVE There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. RESEARCH DESIGN AND METHODS Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. <a>RESULTS Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a> CONCLUSIONS In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.

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Trends of use of SGLT2 inhibitors in Qatar

10.29117/quarfe.2021.0108 ◽

2021 ◽

Author(s):

Nancy Zaghloul ◽

Ahmed Awaisu ◽

Ahmed Mahfouz ◽

Sumaya Al Saadi ◽

Hazem Elewa

Keyword(s):

Cross Sectional Study ◽

Slight Reduction ◽

Mena Region ◽

Cross Sectional ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Glucosidase Inhibitors ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Progression Of Renal Disease

Background: Type 2 diabetes mellitus (T2DM) represents a growing health challenge in Qatar and worldwide. T2DM is associated with a high risk of cardiovascular (CV) morbidity and mortality, and progression of renal disease. Sodium glucose co-transporter 2 inhibitors (SGLT2is) are the most recently approved class of glucose lowering medications (GLMs). To date, there is a limited knowledge about the adoption of SGLT2is by clinicians compared to other oral GLMs in Qatar and Middle East and North Africa (MENA) region. Accordingly, this proposed study aims to explore the trends in SGLT2is use compared to other oral GLMs in Qatar from 2016 to 2020. Methods: This is a descriptive, retrospective cross-sectional study where information on all oral GLMs prescriptions dispensed as in- or out-patient from 2016 to 2020 in all Hamad Medical Corporation (HMC) hospitals were collected. Outcomes included the number and relative frequency of quarterly prescriptions of different oral GLMs classes [metformin, sulfonylureas (SUs), dipeptidyl peptidase 4 inhibitors (DPP-4is), thiazolidinediones (TZDs), meglitinides (MEGs), α-glucosidase inhibitors (AGIs), and SGLT2is] from 2016 to 2020. Results: Overall, the prescription rate of GLMs increased during the last five years. SGLT2is use increased over the years after being introduced to the formulary in 2017, replacing SUs which exhibited significant decline between 2017 and 2020. There was a slight reduction in metformin use, and a slight increase in DPP-4is use. TZDs, MEGs, and AGIs prescriptions remained stable. Among SGLT2is, empagliflozin showed considerable increase on the expense of dapagliflozin which decreased significantly by the end of 2018. Conclusion: SGLT2is have been gradually replacing SUs in Qatar and the trend of their use is similar to that reported in other countries. The trend among SGLT2is suggests greater preference for empagliflozin over dapagliflozin.

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Clinical trial registration, reporting, publication and FDAAA compliance: a cross-sectional analysis and ranking of new drugs approved by the FDA in 2012

BMJ Open ◽

10.1136/bmjopen-2015-009758 ◽

2015 ◽

Vol 5 (11) ◽

pp. e009758 ◽

Cited By ~ 42

Author(s):

Jennifer E Miller ◽

David Korn ◽

Joseph S Ross

Keyword(s):

Clinical Trial ◽

New Drugs ◽

Trial Registration ◽

Clinical Trial Registration ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Postmarket studies required by the US Food and Drug Administration for new drugs and biologics approved between 2009 and 2012: cross sectional analysis

BMJ ◽

10.1136/bmj.k2031 ◽

2018 ◽

pp. k2031 ◽

Cited By ~ 18

Author(s):

Joshua D Wallach ◽

Alexander C Egilman ◽

Sanket S Dhruva ◽

Margaret E McCarthy ◽

Jennifer E Miller ◽

...

Keyword(s):

Drug Administration ◽

Food And Drug Administration ◽

New Drugs ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

The Us ◽

Sectional Analysis

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Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

10.2337/figshare.12970958.v1 ◽

2020 ◽

Author(s):

Aimin Yang ◽

Hongjiang Wu ◽

Eric S.H. Lau ◽

Ronald C.W. Ma ◽

Alice P.S. Kong ◽

...

Keyword(s):

Hong Kong ◽

Glycemic Control ◽

Severe Hypoglycemia ◽

Population Based ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Patients With Diabetes ◽

Lowering Drug ◽

Design And Methods

OBJECTIVE There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. RESEARCH DESIGN AND METHODS Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. <a>RESULTS Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a> CONCLUSIONS In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.

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Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.121.008381 ◽

2021 ◽

Author(s):

Veer Sangha ◽

Kasia Lipska ◽

Zhenqiu Lin ◽

Silvio E. Inzucchi ◽

Darren K. McGuire ◽

...

Keyword(s):

Randomized Clinical Trials ◽

The United States ◽

Cardiovascular Death ◽

Cross Sectional Study ◽

Atherosclerotic Cardiovascular Disease ◽

Medicare Beneficiaries ◽

Cross Sectional ◽

Dipeptidyl Peptidase 4 ◽

Sodium Glucose Cotransporter ◽

Dipeptidyl Peptidase 4 Inhibitors

Background: Evidence from large randomized clinical trials supports the benefit of sodium-glucose cotransporter-2 inhibitors (SGLT2i) to improve cardiovascular and kidney outcomes in patients with type 2 diabetes mellitus (T2DM) with or at high risk for atherosclerotic cardiovascular disease or chronic kidney disease. Considering this evidence, which has been expanding since the product label indication for empagliflozin to reduce risk of cardiovascular death in 2016, clinician-level variation in the prescription of SGLT2i among US Medicare beneficiaries was evaluated. Methods: Antihyperglycemic medication prescribers were identified as those physicians and advanced practice providers prescribing metformin in Medicare part D prescriber data. In this cross-sectional study, the proportion prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. SGLT2i use was compared with other second-line antihyperglycemic medication classes, sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP4is). Results: Among 232,523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018 (diabetes-treating clinicians), 45,255 (19.5%) prescribed SGLT2i. There was substantial variation across specialties - from 72% of endocrinologists to 14% of cardiologists who prescribed metformin also prescribed SGLT2i. Between 2014 and 2018, the number prescribing SGLT2i increased 5 fold from 9,048 in 2014 to 45,255 in 2018. Among clinicians who prescribed both sulfonylureas and SGLT2i in 2018, SGLT2i was prescribed to a median 33 beneficiaries for every 100 prescribed sulfonylureas (IQR 18, 67). SGLT2i use relative to sulfonylureas increased from 19 (IQR 11, 34) per 100 in 2014 to 33 (IQR 18, 67) per 100 in 2018 (P-trend <0.001). Conclusions: Eighty percent of clinicians prescribing metformin to Medicare beneficiaries did not prescribe SGLT2i in 2018. Moreover, sulfonylureas prescriptions were 3 times more frequent than those of SGLT2is, although a pattern of increasing uptake may portend future trends. These findings highlight a baseline opportunity to improve care and outcomes for patients with T2DM.

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Pharmacogenetics of new classes of antidiabetic drugs

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2021.5646 ◽

2021 ◽

Author(s):

Selma Imamovic Kadric ◽

Aida Kulo Cesic ◽

Tanja Dujic

Keyword(s):

Drug Targets ◽

Antidiabetic Drugs ◽

Atherosclerotic Cardiovascular Disease ◽

Protective Effects ◽

Metabolizing Enzymes ◽

Dipeptidyl Peptidase 4 ◽

Drug Classes ◽

Sodium Glucose Cotransporter ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Glucagon Like Peptide 1

Type 2 diabetes (T2D) has a continuously rising prevalence worldwide. Pharmacogenetics has been recognized as a promising concept for pharmacological treatment of T2D, as antidiabetic drugs are not equally effective and safe for all patients, and the costs of diabetes treatment are increasing. The latest published guidelines on T2D treatment firmly endorse the use of newer antidiabetic drugs, sodium-glucose cotransporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-IVi), and glucagon-like peptide-1 receptor agonists (GLP-1RA), considering their satisfactory pharmacological effect and good safety profile. Furthermore, SGLT2i and GLP-1RA show protective effects in patients with established atherosclerotic cardiovascular disease and chronic kidney disease. However, there has been growing evidence that the effectiveness and safety of these drug classes could depend on genetic variability. Here we summarized the results of the published studies on the pharmacogenetic biomarkers for the three drug classes. A number of genetic variations have been investigated so far. The explored candidate genes mostly encode drug targets, drug-metabolizing enzymes, and genes linked to T2D risk. Although many of the results are promising, it is still necessary to obtain more information from larger controlled studies to confirm their clinical significance. This approach may lead towards more personalized treatment for patients with T2D.

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Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

10.2337/figshare.13574600 ◽

2021 ◽

Author(s):

Hui Shao ◽

Michael Laxy ◽

Stephen R. Benoit ◽

Yiling J. Cheng ◽

Edward W. Gregg ◽

...

Keyword(s):

Decomposition Analysis ◽

Fee For Service ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Drug Classes ◽

Out Of Pocket Payments ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Main Driver ◽

Glucagon Like Peptide 1 ◽

Total Payment

Objective To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018. Methods We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. Results Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase. Conclusion Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver.

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