Trends in anti-hyperglycaemic drug usage among Danish type 2 diabetes patients on second-line treatment and beyond: A nationwide cohort study

The paradigm shift introduced by the glucagon-like peptide-1 (GLP1) receptor agonist and sodium-glucose co-transporter-2 (SGLT2) inhibitor classes of drugs has led to changes in treatment practices in Denmark. The aim of this study was to investigate what these changes were before and after the implementation of the 2018 guidelines in Denmark. RESEARCH DESIGN AND METHODS Registry data on prescriptions was linked with other registries to create a descriptive overview of treatment patterns was carried out for a nationwide cohort of all individuals receiving at least two non-insulin anti-diabetic drugs (NIADs) between 2012 and 2021.

A cohort of 66,188 individuals was identified. The treatment patterns reflected significantly higher use of SGLT2 and GLP1 over time, eclipsing all other drugs, except for insulin, at later treatment stages. First-line use of SGLT2 and GLP1 also became higher over time, as did their likelihood of prescription at later stages. Their combined use rivaled insulin usage at similar stages by 2021. First-line use for women were high in the GLP1 group.

Our study finds that GLP1 and SGLT2 are used extensively for individuals who have tried multiple NIADs and may delay the use of insulin. Furthermore, there is an increased trend in their first-line use. Key messages What is already known on this subject ○ Increase in use of SGLT2 and GLP1 is documented, but changes in treatment patterns specifically for a cohort of people with type 2 diabetes before and after the publication of the 2018 treatment guidelines has not. What did we find? ○ A marked increase in SGLT2 and GLP1 utilization, an indication that insulin initiation is postponed following this, and a preference for GLP1 in younger people in the cohort. What are the implications of our findings? ○ Introduction of SGLT2 and GLP1 has led to major changes in the treatment practice of type 2 diabetes. Systematic population-based monitoring is highly warranted to ensure that treatment practice remain compliant with clinical guidelines recommendations. Competing Interest Statement PV is the head of research at Steno Diabetes Center North Denmark, funded by the Novo Nordisk Foundation. HVBL has received partial funding for his PhD from Steno Diabetes Center North Denmark, which in turn is funded by the Novo Nordisk Foundation, and additional funding from Boehringer Ingelheim. SPJ has received an institutional research grant from Novo Nordisk. MHJ is full-time employee at Novo Nordisk A/S and owns stocks in Novo Nordisk A/S. FWU has no conflict of interest. Funding Statement This study was supported by Steno Diabetes Center North Denmark. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of the Danish National Committee on Health Research Ethics waived ethical approval for this work. Data access was authorised by the Danish Health Data Authority and Statistics Denmark (project ID 703382) as part of a larger project. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes RECORD statement checklist added. I have to put in more words to this revision summary so here I got some more words. Data Availability Underlying micro-data are not available, as they are protected on a research server. All relevant aggregate data is made available in the manuscript or appendices.