Article Impact Level: HIGH Data Quality: STRONG Summary of British Journal of Clinical Pharmacology, bcp.16231. https://doi.org/10.1111/bcp.16231 Dr. Tamara Y. Milder et al.
Points
- The study analyzed trends in the first add-on anti-hyperglycaemic therapy to metformin in Australians aged 40+ using Pharmaceutical Benefits Scheme (PBS) data from 2018 to 2020.
- Approximately one-third (12,946) of the 38,747 individuals who started metformin therapy added anti-hyperglycaemic medication within two years, slightly increasing from 32.3% in 2018 to 34.8% in 2020.
- During the study period, the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) as add-on therapies increased, while the use of dipeptidyl peptidase-4 inhibitors and sulfonylureas declined.
- One-third of patients who received add-on therapy began it on the same day as metformin, indicating a preference for combination therapy from the outset.
- The study highlights the need for policy and advocacy efforts to increase the use of add-on therapies like SGLT2i and GLP-1 RA, aligning with updated type 2 diabetes management guidelines emphasizing cardiorenal benefits.
Summary
Researchers conducted a study to examine contemporary trends in the use, timing, and type of first add-on anti-hyperglycaemic therapy to metformin among Australians aged 40 years and older. Utilizing dispensing records from a 10% random sample of Pharmaceutical Benefits Scheme (PBS) eligible individuals, the study included participants who initiated metformin between January 1, 2018, and December 31, 2020. The primary outcome measured was initiating a first add-on anti-hyperglycaemic medication within two years of starting metformin, with analyses stratified by the year of metformin initiation.
Out of 38,747 individuals who began metformin therapy during the study period, approximately one-third (n = 12,946) received an add-on therapy within two years. The proportion of patients receiving add-on therapy increased slightly over time, from 32.3% in 2018 to 34.8% in 2020. Among those who initiated add-on therapy after metformin, sodium-glucose cotransporter 2 inhibitors (SGLT2i) rose from 28.8% in 2018 to 35.0% in 2020. Similarly, glucagon-like peptide-1 receptor agonists (GLP-1 RA) usage increased from 3.0% to 9.6% over the same period. In contrast, dipeptidyl peptidase-4 inhibitors and sulfonylureas as first add-on therapies decreased, while insulin usage remained stable. Notably, one-third of patients who received add-on therapy initiated it on the same day as metformin, indicating a preference for initial combination therapy.
The study concludes that while there is a growing trend in prescribing SGLT2i and GLP-1 RA as first add-on therapies to metformin, this population’s overall prevalence of add-on therapy remains low. Given the shift in type 2 diabetes management guidelines towards agents with proven cardiorenal benefits, these findings underscore the need for policy and prescriber-level advocacy. Promoting the increased use of add-on therapies like SGLT2i and GLP-1 RA is critical to reducing morbidity and mortality associated with type 2 diabetes.
Link to the article: https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.16231
References Milder, T. Y., Lin, J., Pearson, S., Greenfield, J. R., Day, R. O., Stocker, S. L., Neuen, B. L., Falster, M. O., & De Oliveira Costa, J. (2024). Use of, time to, and type of first add‐on anti‐hyperglycaemic therapy to metformin in Australia, 2018–2022. British Journal of Clinical Pharmacology, bcp.16231. https://doi.org/10.1111/bcp.16231
