Open AccessDifferent patterns of second‐line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): A multinational observational study
Author(s) -
Persson Frederik,
Bodegard Johan,
Lahtela Jorma T.,
Nyström Thomas,
Jørgensen Marit E.,
Jensen Majken Linneman,
Gulseth Hanne L.,
Thuresson Marcus,
Hoti Fabian,
Nathanson David,
Norhammar Anna,
Birkeland Kåre I.,
Eriksson Johan G.,
Eriksson Jan W.
Publication year - 2018
Publication title -
endocrinology, diabetes and metabolism
Language(s) - English
Resource type - Journals
ISSN - 2398-9238
DOI - 10.1002/edm2.36
Subject(s) - metformin , type 2 diabetes , medicine , medical prescription , population , drug class , diabetes mellitus , demography , insulin , drug , endocrinology , pharmacology , environmental health , sociology
Summary Aims The understanding of second‐line use of glucose‐lowering drugs ( GLD s) in the general population with type 2 diabetes (T2D) treatment is important as recent results have shown cardiovascular benefits with sodium‐glucose cotransporter‐2 inhibitors ( SGLT ‐2i) and glucagon‐like peptide‐1 receptor agonists ( GLP ‐1 RA ). Our aim was to describe second‐line GLD treatment patterns in four Nordic countries. Methods All T2D patients treated with GLD between 2006 and 2015 were identified in prescribed drug registries in Denmark, Finland, Norway and Sweden, and linked with National Patient and Cause of Death Registries. Second‐line treatment was defined as a prescription of a second GLD class following ≥6 months of metformin monotherapy. Index was the date of first dispense of the second‐line drug. Results A rapid uptake of newer GLD s ( GLP ‐1 RA , DPP ‐4i and SGLT ‐2i) over the 10‐year observation period was seen in Denmark, Finland and Norway, while slower in Sweden. In 2015, 33,880 (3.1%) of 1,078,692 T2D patients initiated second‐line treatment, and newer GLD s were more commonly used in Finland (92%), Norway (71%) and Denmark (70%) vs Sweden (44%). In 2015, the use of older GLD s (insulin and sulphonylureas) was 7‐fold greater in Sweden compared to Finland (49% vs 7%), and 1.6‐fold greater compared with Denmark and Norway (49% vs 30% and 29%, respectively). Conclusions Despite comparable demography and healthcare systems in four neighbouring countries, surprisingly large differences in second‐line use of newer GLD s were found. With recent evidence of potential cardiovascular benefits with newer GLD s, such differences may have an important impact on cardiovascular outcomes.