Treatment trajectories for Danish individuals with type 2 diabetes in the era of emerging glucose‐lowering therapies

Sep 16, 2024Diabetes, obesity & metabolism

Treatment patterns over time for Danish people with type 2 diabetes as new blood sugar medicines become available

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Abstract

A total of 260,393 individuals initiated a new glucose-lowering therapy class in Denmark from 2016 to 2023.

Initiators of GLP-1 receptor agonists (GLP-1RAs) increased by 6-fold, while those of sodium-glucose co-transporter-2 inhibitors (SGLT-2is) rose by 3-fold during the study period.
The median HbA1c level at the start of treatment with GLP-1RAs or SGLT-2is decreased from 67-68 mmol/mol in 2016-2017 to 57-58 mmol/mol in 2022-2023.
The proportion of individuals starting additional glucose-lowering therapy within 2 years after initiating metformin increased from 25% in 2016 to 40% in 2021.
Among those with established cardiorenal disease, 22% used SGLT-2is and 18% used GLP-1RAs after 2.5 years, compared to 17% and 21% in those without cardiorenal disease.

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AIM: To analyse patterns of glucose-lowering therapies among people with type 2 diabetes (T2D) in Denmark from 2016 to 2023.

MATERIALS AND METHODS: We examined time trends in the clinical profiles of people with T2D who initiated different glucose-lowering therapy classes for the first time. We furthermore investigated individual-level treatment trajectories following first-ever glucose-lowering therapy in people with or without cardiorenal disease. The study utilized data from the nationwide Danish health registries and included all individuals who filled a first-ever prescription for metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose co-transporter-2 inhibitors (SGLT-2is) or insulin, excluding those without HbA1c-confirmed T2D or probable type 1 diabetes.

RESULTS: We included 260 393 individuals initiating a new glucose-lowering therapy class from 2016 to 2023, during which there were 6- and 3-fold increases in initiators of GLP-1RAs and SGLT-2is, respectively. The median HbA1c level at treatment initiation with GLP-1RAs or SGLT-2is decreased, from 67-68 mmol/mol in 2016-2017 to 57-58 mmol/mol in 2022-2023. Among individuals who initiated metformin as first-line therapy, the proportion who started additional glucose-lowering therapy within 2 years increased from 25% in 2016 to 40% in 2021. Among the 38% of individuals who had established cardiorenal disease when they initiated first-ever glucose-lowering therapy in 2020, 22% used SGLT-2is and 18% GLP-1RAs after 2.5 years, compared with 17% and 21% among initiators without cardiorenal disease, respectively.

CONCLUSIONS: Our study documents a trend towards earlier T2D treatment intensification and an increase in the use of GLP-1RAs and SGLT-2is in Denmark. However, optimal T2D treatment is still not received by most individuals with early T2D and established cardiorenal disease.

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Treatment trajectories for Danish individuals with type 2 diabetes in the era of emerging glucose‐lowering therapies

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