Trends in Prescribing Preferences for Antidiabetic Medications Among Patients With Type 2 Diabetes in the U.K. With and Without Chronic Kidney Disease, 2006–2020
Open accessAbstract
OBJECTIVE: To evaluate trends in antidiabetic medication initiation patterns among patients with type 2 diabetes mellitus (T2DM) with and without chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS: A retrospective cohort study using the UK Clinical Practice Research Datalink (2006–2020) was conducted to evaluate the overall, first-, and second line (after metformin) medication initiation patterns among patients with CKD (n = 38,622) and those without CKD (n = 230,963) who had T2DM. RESULTS: Relative to other glucose-lowering therapies, metformin initiations declined overall but remained the first-line treatment of choice for both patients with and those without CKD. Sodium-glucose cotransporter-2 (SGLT2i) use increased modestly among patients with CKD, but this increase was more pronounced among patients without CKD; by 2020, patients without CKD, compared with patients with CKD, were three (28.5% vs. 9.4%) and six (46.3% vs. 7.9%) times more likely to initiate SGLT2i overall and as second-line therapy, respectively. Glucagon-like peptide 1 receptor agonist (GLP-1RA) use was minimal regardless of CKD status (<5%), whereas both dipeptidyl peptidase-4 inhibitor (DPP4i) and sulfonylurea use remained high among patients with CKD. For instance, by 2020, and among patients with CKD, DPP4i and sulfonylureas constituted 28.3% and 20.6% of all initiations, and 57.4% and 30.3% of second-line initiations, respectively. CONCLUSIONS: SGLT2i use increased among patients with T2DM, but this increase was largely driven by patients without CKD. Work is needed to identify barriers associated with the uptake of therapies with proven cardiorenal benefits (e.g., SGLT2i, GLP-1RA) among patients with CKD.
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The adoption of SGLT2is and GLP-1RAs has been slow in those with type 2 diabetes and comorbid cardiorenal conditions.
“Despite consensus recommendations and accumulating clinical evidence, the adoption of SGLT2is and GLP-1RAs has been slow in those with type 2 diabetes and comorbid cardiorenal conditions [10, 11].”
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- Authors
- Liaw, J., Harhay, M., Setoguchi, S., Gerhard, T., & Dave, C. V.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- University of Pennsylvania Health System (US)
- Corresponding author
- Dave, Chintan V.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-08-19
- Volume
- 45
- Issue
- 10
- Pages
- 2316-2325
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC12081776
- OpenAlex
- W4292371522
- Cited by
- 21
- References
- 32
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 3 · 2022: 2
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Environmental Health Sciences (P30ES005022)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- type 2 diabetes, chronic kidney disease, metformin, SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, prescribing trends, second-line therapy, cardiorenal benefits
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Diabetes Mellitus, Type 2, Dipeptidyl-Peptidases and Tripeptidyl-Peptidases, Glucose, Humans, Hypoglycemic Agents, Metformin, Retrospective Studies, Sodium, Sulfonylurea Compounds, Renal Insufficiency, Chronic, Glucagon-Like Peptide 1, Dipeptidyl-Peptidase IV Inhibitors
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