Long-term Trends in Antidiabetes Drug Usage in the US: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes
Long-term Trends in Antidiabetes Drug Usage in the US: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes
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DOI：
10.2337/dc17-1414
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发表时间：
2018-01-01
期刊：
影响因子：
16.2
通讯作者：
Paul, Sanjoy K.
中科院分区：
文献类型：
--
作者：
Montvida, Olga;Shaw, Jonathan;Paul, Sanjoy K.
目的探讨抗糖尿病药物（ADD）处方和强化模式的时间趋势，沿着血糖水平和合并症，以及新型ADD在延迟诊断为2型糖尿病患者开始胰岛素治疗方面的可能益处。（n = 1，023，340）来自美国Centricity电子病历。确定在一线二甲双胍治疗后开始二线ADD的患者（子队列1，n = 357，482）;进一步探索三线治疗选择。从2005年到2016年，二甲双胍的一线使用增加（60-77%），磺脲类药物减少（20-8%）。在二甲双胍治疗后平均3.4年的随访期间，48%的患者在平均HbA（1c）为8.4%时开始了第二次ADD。在亚队列1中，尽管磺脲类药物作为二线治疗的使用率下降（60-46%），但它仍然是最受欢迎的第二种ADD选择。胰岛素（7-17%）和二肽基肽酶-4抑制剂（DPP-4 i）（0.4-21%）的使用增加。在过去10年中，胰岛素和磺脲类药物强化治疗的比率没有下降。与磺脲类药物组（6.3年，P < 0.05）相比，DPP-4 i二线治疗组（7.1年）和胰高血糖素样肽1受体激动剂二线治疗组（6.6年）开始胰岛素治疗的限制性平均时间略长。尽管引入了更新的治疗方法，磺脲类药物仍然是最受欢迎的二线药物，磺脲类药物和胰岛素的强化率随时间推移保持一致。与磺脲类药物相比，肠促胰岛素为基础的治疗与治疗强化需求的小幅延迟相关。
OJBECTIVETo explore temporal trends in antidiabetes drug (ADD) prescribing and intensification patterns, along with glycemic levels and comorbidities, and possible benefits of novel ADDs in delaying the need for insulin initiation in patients diagnosed with type 2 diabetes.RESEARCH DESIGN AND METHODSPatients with type 2 diabetes aged 18-80 years, who initiated any ADD, were selected (n = 1,023,340) from the U.S. Centricity Electronic Medical Records. Those who initiated second-line ADD after first-line metformin were identified (subcohort 1, n = 357,482); the third-line therapy choices were further explored.RESULTSFrom 2005 to 2016, first-line use increased for metformin (60-77%) and decreased for sulfonylureas (20-8%). During a mean follow-up of 3.4 years post metformin, 48% initiated a second ADD at a mean HbA(1c) of 8.4%. In subcohort 1, although sulfonylurea usage as second-line treatment decreased (60-46%), it remained the most popular second ADD choice. Use increased for insulin (7-17%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.4-21%). The rates of intensification with insulin and sulfonylureas did not decline over the last 10 years. The restricted mean time to insulin initiation was marginally longer in second-line DPP-4i (7.1 years) and in the glucagon-like peptide 1 receptor agonist group (6.6 years) compared with sulfonylurea (6.3 years, P < 0.05).CONCLUSIONSMost patients initiate second-line therapy at elevated HbA(1c) levels, with highly heterogeneous clinical characteristics across ADD classes. Despite the introduction of newer therapies, sulfonylureas remained the most popular second-line agent, and the rates of intensification with sulfonylureas and insulin remained consistent over time. The incretin-based therapies were associated with a small delay in the need for therapy intensification compared with sulfonylureas.