Use of newer glucose-lowering drugs, combinations increasing in Denmark

During the past 2 decades, prescriptions for sulfonylureas and insulin have decreased and use of newer glucose-lowering drugs, including DPP-IV inhibitors, glucagon-like peptide-1 receptor agonists, SGLT2 inhibitors and their combinations, has increased among Denmark residents with type 2 diabetes, according to findings presented at the 52nd European Association for the Study of Diabetes Annual Meeting.

“A group of new glucose-lowering drugs were launched in Denmark during the recent years,” Majken Linnemann Jensen, PhD, of Steno Diabetes Center in Gentofte, Denmark, said during the presentation. “Back in 2007, DPP-IV inhibitors were launched together with GLP-1 receptor agonists, and in 2012 came SGLT2 inhibitors. The international guidelines reflect that we now have a wide range of prescription drugs available, and the Danish guidelines are identical to the international ones.”

Jensen and colleagues evaluated data from the National Patient Register and the Danish Adult Diabetes Database on 412,290 adults (median age, 63 years; 53% men) with type 2 diabetes with at least one glucose-lowering drug filled prescription between 1996 to 2014 covering 3 million person-years. Follow-up was conducted for a median of 6 years. Drug exposure was calculated from the first fill of a glucose-lowering drug prescription and information on daily prescribed dose was used to determine the duration of drug exposure.

“We wanted to map all use of glucose-lowering drugs among all patients with type 2 diabetes in Denmark during the last 19 years,” Jensen said. “In particular, we wanted to explore the combination drug therapy use among the patients.”

Seventy-three percent of participants were exposed to one or more glucose-lowering drugs by the end of 2014, for a total exposure of 2.1 million person-years. Metformin monotherapy accounted for 27.5% of the person-years, and other monotherapies accounted for 47.8%. In 2014, the most common combination therapy was metformin plus sulfonylureas (6.3% of total glucose-lowering drug exposure), followed by metformin plus insulin (6.1% of total glucose-lowering drug exposure) and metformin plus DPP-IV inhibitors (5.5% of total glucose-lowering drug exposure).

The proportion of participants on monotherapy with sulfonylureas decreased from 51% in 1996 to 3.7% in 2014. Fourteen percent of participants were using DPP-IV inhibitors by the end of 2014, 8.1% were using GLP-1 inhibitors and 0.7% were using SGLT2 inhibitors.

“Consistently throughout the 19 years, one out of four patients were not treated with glucose-lowering drugs,” Jensen said. “The use of sulfonylureas has decline markedly, and the proportion of insulin users has decreased. The use of DPP-IV [inhibitors], GLP-1 [receptor agonists] and SGLT2 [inhibitors] has steadily increased since their introduction.” – by Amber Cox

Reference:

Jensen ML, et al. OP 120. Presented at: 52nd EASD Annual Meeting; Sept. 12-16, 2016; Munich.

Disclosure: Jensen reports receiving honorarium from AstraZeneca and owning stock in Novo Nordisk.