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Treatment patterns and associated factors in 14 668 people with type 2 diabetes initiating a second‐line therapy: Results from the global DISCOVER study programme
Author(s) -
Nicolucci Antonio,
Charbonnel Bernard,
Gomes Marília B.,
Khunti Kamlesh,
Kosiborod Mikhail,
Shestakova Marina V.,
Shimomura Iichiro,
Watada Hirotaka,
Chen Hungta,
CidRuzafa Javier,
Fenici Peter,
Hammar Niklas,
Surmont Filip,
Tang Fengming,
Pocock Stuart
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13830
Subject(s) - metformin , medicine , type 2 diabetes , combination therapy , diabetes mellitus , observational study , pharmacology , endocrinology , insulin
Aim To evaluate treatment data from DISCOVER (NCT02322762 and NCT02226822), a global, prospective, observational study programme of patients with type 2 diabetes initiating a second‐line glucose‐lowering therapy. Materials and Methods Data were collected using a standardized case report form. First‐ and second‐line treatments were assessed in 14 668 patients from 37 countries across six regions. Among patients prescribed first‐line metformin monotherapy, Firth logistic regression models were used to assess factors associated with second‐line treatment choices. Results The most common first‐line therapies were metformin monotherapy (57.9%) and combinations of metformin with a sulphonylurea (14.6%). The most common second‐line therapies were combinations of metformin with other agents (72.2%), including dipeptidyl peptidase‐4 (DPP‐4) inhibitors (25.1%) or sulphonylureas (21.3%). Among patients prescribed first‐line metformin monotherapy, the most common second‐line therapies were combinations of metformin with a DPP‐4 inhibitor [32.8%; across‐region range (ARR): 2.4%‐51.3%] or a sulphonylurea (30.0%; ARR: 18.3%‐63.6%); only a few patients received combinations of metformin with sodium‐glucose co‐transporter‐2 inhibitors (6.7%; ARR: 0.0%‐10.8%) or glucagon‐like peptide‐1 receptor agonists (1.9%; ARR: 0.1%‐4.5%). Both clinical and non‐medical factors were associated with choice of second‐line therapy after metformin monotherapy. Conclusions Fewer patients than expected received metformin monotherapy at first line, and the use of newer therapies at second line was uncommon in some regions of the world. Patients' socioeconomic status was associated with treatment patterns, suggesting that therapy choices are influenced by cost and access.