Contemporary trends in the utilization of second-line pharmacological therapies for type 2 diabetes in the United States and the United Kingdom.
Contemporary trends in the utilization of second-line pharmacological therapies for type 2 diabetes in the United States and the United Kingdom.
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美国和英国 2 型糖尿病二线药物治疗的当代趋势。
DOI：
10.1111/dom.15196
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Patorno,Elisabetta
中科院分区：
文献类型：
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作者：
Abrahami,Devin;D'Andrea,Elvira;Yin,Hui;Kim,SeoyoungC;Paik,JulieM;Wexler,Deborah;Azoulay,Laurent;Patorno,Elisabetta
目的 研究美国和英国 2 型糖尿病 (T2D) 患者开始一线二甲双胍治疗的二线降糖治疗趋势，总体情况以及按心血管疾病 (CVD) 亚组和日历时间进行的分析。方法使用美国 Optum Clinformatics 和英国临床实践研究数据链，我们确定了从 2013 年到 2013 年分别开始一线二甲双胍或磺脲类单药治疗的 T2D 成人患者。 2019 年。在这两个队列中，我们确定了截至 2021 年 6 月的二线药物模式。我们根据 CVD 和日历时间对模式进行分层，以调查快速发展的治疗指南的影响。结果我们分别在美国和英国确定了 148-511 名和 169-316 名开始接受二甲双胍单药治疗的患者。在整个研究期间，磺脲类和二肽基肽酶 4 抑制剂是美国（分别为 43.4% 和 18.2%）和英国（分别为 42.5% 和 35.8%）最常用的二线药物。 2018年之后，钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂在美国和英国更常用作二线药物，尽管这些药物并未优先用于CVD患者。一线磺脲类药物的起始治疗不太常见，大多数磺脲类起始药物都添加了二甲双胍作为二线药物。结论这项国际队列研究表明，在美国和英国，磺脲类药物仍然是继二甲双胍之后最常见的二线药物。尽管有建议，但具有心血管益处的新型降糖疗法的使用率仍然很低。
AimTo examine trends of second‐line glucose‐lowering therapies among patients with type 2 diabetes (T2D) initiating first‐line metformin in the United States and the United Kingdom, overall and by subgroups of cardiovascular disease (CVD) and calendar time.MethodsUsing the US Optum Clinformatics and the UK Clinical Practice Research Datalink, we identified adults with T2D who initiated first‐line metformin or sulphonylurea monotherapy, separately, from 2013 to 2019. Within both cohorts, we identified patterns of second‐line medications through June 2021. We stratified patterns by CVD and calendar time to investigate the impact of rapidly evolving treatment guidelines.ResultsWe identified 148 511 and 169 316 patients initiating treatment with metformin monotherapy in the United States and the United Kingdom, respectively. Throughout the study period, sulphonylureas and dipeptidyl peptidase‐4 inhibitors were the most frequently initiated second‐line medications in the United States (43.4% and 18.2%, respectively) and the United Kingdom (42.5% and 35.8%, respectively). After 2018, sodium‐glucose co‐transporter 2 inhibitors and glucagon‐like peptide‐1 receptor agonists were more commonly used as second‐line agents in the United States and the United Kingdom, although these agents were not preferentially prescribed among patients with CVD. Initiation of first‐line sulphonylureas was much less common, and most sulphonylurea initiators had metformin added as the second‐line agent.ConclusionsThis international cohort study shows that sulphonylureas remain the most common second‐line medications prescribed following metformin in both the United States and the United Kingdom. Despite recommendations, the use of newer glucose‐lowering therapies with cardiovascular benefits remains low.