Visual Abstract
Recent utilization trends and predictors of first-line antidiabetic treatment in patients with type 2 diabetes (T2D) remain unexplored.
Using Medicare and a large U.S. health insurance database of commercially-insured patients (Clinformatics), we identified adult patients with T2D who initiated first-line antidiabetic treatment during 2013-2019. Quarterly utilization trends were plotted overall and by cardiovascular disease (CVD). We estimated predictors of first-line antidiabetic treatment, using metformin, the recommended first-line treatment for T2D, as the common referent.
Metformin was the most frequently initiated medication (80.6% in Medicare and 83.1% in Clinformatics) (Figure). Sulfonylureas were used by 8.7% in Medicare and by 4.7% in Clinformatics. Both populations had low use of SGLT-2 inhibitors (SGLT-2i, 0.8% [Medicare] and 1.7% [Clinformatics]) and GLP-1 receptor agonists (GLP-1RA, 1.0% [Medicare] and 3.5% [Clinformatics]), with increasing trends over time (P < 0.01), in particular among patients with CVD. Initiators of SGLT-2i and GLP-1RA were more likely to be younger, to have prevalent CVD or higher socioeconomic status compared with initiators of metformin.
Among adult patients with T2D, metformin was the most frequent first-line treatment. The use of SGLT-2i and GLP-1RA remained low, though with a greater use among patients with CVD.
H. Shin: None. S. Schneeweiss: Other Relationship; Self; Aetion. R. Glynn: Research Support; Self; AstraZeneca, Kowa Research Institute, Inc., Novartis AG, Pfizer Inc. E. Patorno: Research Support; Self; Boehringer Ingelheim International GmbH, National Institutes of Health.
Brigham and Women’s Hospital; National Institute on Aging (K08AG055670 to E.P.)
