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

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2024-09-16 DOI:10.1111/dom.15912

Anton Pottegård, Jacob H Andersen, Jens Søndergaard, Lotte Rasmussen, Helene Kildegaard, Tina Vilsbøll, Reimar W Thomsen

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Abstract

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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新兴降糖疗法时代丹麦 2 型糖尿病患者的治疗轨迹。

目的：分析2016年至2023年丹麦2型糖尿病（T2D）患者的降糖疗法模式：我们研究了首次使用不同降糖疗法的 2 型糖尿病患者临床概况的时间趋势。此外，我们还调查了患有或未患有心肾疾病的首次接受降糖治疗患者的个体治疗轨迹。研究利用了丹麦全国健康登记处的数据，纳入了所有首次开具二甲双胍、二肽基肽酶-4 抑制剂、胰高血糖素样肽-1 受体激动剂（GLP-1RA）、钠-葡萄糖协同转运体-2 抑制剂（SGLT-2is）或胰岛素处方的人，但不包括那些没有 HbA1c 确认的 T2D 或可能的 1 型糖尿病患者：我们纳入了 260 393 名从 2016 年到 2023 年开始接受新降糖治疗的患者，在此期间，GLP-1RAs 和 SGLT-2is 的患者分别增加了 6 倍和 3 倍。开始使用 GLP-1RAs 或 SGLT-2is 治疗时的 HbA1c 水平中位数从 2016-2017 年的 67-68 mmol/mol 降至 2022-2023 年的 57-58 mmol/mol。在开始使用二甲双胍作为一线疗法的患者中，2年内开始额外降糖治疗的比例从2016年的25%增加到2021年的40%。在2020年开始首次降糖治疗时已患有心肾疾病的38%的患者中，22%的患者在2.5年后使用了SGLT-2is，18%的患者使用了GLP-1RAs，而在没有心肾疾病的患者中，使用SGLT-2is和GLP-1RAs的比例分别为17%和21%：我们的研究表明，丹麦的 T2D 强化治疗有提前的趋势，GLP-1RA 和 SGLT-2is 的使用也有增加。然而，大多数患有早期 T2D 并已确诊心肾疾病的患者仍未接受最佳的 T2D 治疗。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.