NEW HAVEN, CT — Even though the overall uptake of cardioprotective antihyperglycemic drugs has increased as second-line treatments for Type 2 diabetes mellitus, over the last decade, patients who actually have cardiovascular disease were less likely to be prescribed them compared to those without CVD.
That’s according to a new study in BMJ Medicine that suggested, “A strategy is needed to ensure that medication use is concordant with guideline recommendations to improve outcomes of patients with Type 2 diabetes mellitus.”1
The research team, led by Yale University and including participation from the Veterans Affairs Informatics and Computing Infrastructure in Salt Lake City and the Tennessee Valley Healthcare System in Nashville, sought to assess the uptake of second-line aantihyperglycemic drugs among patients with Type 2 diabetes mellitus who are receiving metformin.
The Federated pharmacoepidemiologic evaluation in LEGEND-T2DM involved 10 U.S. electronic health record and administrative claims databases and seven outside the U.S.; all were part of the Observational Health Data Sciences and Informatics network in eight countries from 2011 to the end of 2021.
Data from 4.8 million adult patients were included; all had received metformin monotherapy and had initiated second-line treatments. The database included 4.6 million patients from the United States, 61 382 from Spain, 32, 442 from Germany, 25 ,173 from the UK, 13, 270 from France, 5,580 from Scotland, 4,614 from Hong Kong and 2,322 from Australia.
Defined as the outcome was the incidence of second-line antihyperglycemic drug use—glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors and sulfonylureas—among individuals who were already receiving treatment with metformin. The researchers also evaluated the relative drug class level uptake across cardiovascular risk groups.
“During 2011-21, the combined proportional initiation of the cardioprotective antihyperglycemic drugs (glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors) increased across all data sources, with the combined initiation of these drugs as second-line drugs in 2021 ranging from 35.2% to 68.2% in the U.S. databases, 15.4% in France, 34.7% in Spain, 50.1% in Germany, and 54.8% in Scotland, the researchers pointed out.
They advised, however, that from 2016 to 2021, in some U.S. and non-U.S. databases, “uptake of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors increased more significantly among populations with no cardiovascular disease compared with patients with established cardiovascular disease.”
In fact, the authors noted that no data source provided evidence of a greater increase in the uptake of these two drug classes in populations with cardiovascular disease compared with no cardiovascular disease.
- Khera R, Dhingra LS, Aminorroaya A, Li K, Zhou JJ, et. al. Multinational patterns of second line antihyperglycaemic drug initiation across cardiovascular risk groups: federated pharmacoepidemiological evaluation in LEGEND-T2DM. BMJ Med. 2023 Oct 6;2(1):e000651. doi: 10.1136/bmjmed-2023-000651. PMID: 37829182; PMCID: PMC10565313.
