TY - JOUR
T1 - Prescribing paradigm shift?
T2 - Applying the 2019 European Society of Cardiology-led guidelines on diabetes, prediabetes, and cardiovascular disease to assess eligibility for sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonists as first-line monotherapy (or add-on to metformin monotherapy) in type 2 diabetes in Scotland
AU - Scottish Diabetes Research Network Epidemiology Group
AU - Caparrotta, Thomas M.
AU - Blackbourn, Luke A. K.
AU - McGurnaghan, Stuart J.
AU - Chalmers, John
AU - Lindsay, Robert
AU - McCrimmon, Rory
AU - McKnight, John
AU - Wild, Sarah
AU - Petrie, John R.
AU - Philip, Sam
AU - McKeigue, Paul M.
AU - Webb, David J.
AU - Sattar, Naveed
AU - Colhoun, Helen M.
N1 - © 2020 by the American Diabetes Association.
PY - 2020/9
Y1 - 2020/9
N2 - OBJECTIVEIn 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is.RESEARCH DESIGN AND METHODSUsing a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated.RESULTSOf the 265,774 people with T2D in Scotland, 53,194 (20.0% of those with T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions.CONCLUSIONSThus, 80,830 (30.4%) of all those with T2D (n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration.
AB - OBJECTIVEIn 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is.RESEARCH DESIGN AND METHODSUsing a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated.RESULTSOf the 265,774 people with T2D in Scotland, 53,194 (20.0% of those with T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions.CONCLUSIONSThus, 80,830 (30.4%) of all those with T2D (n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration.
KW - Aged
KW - Cardiology/organization & administration
KW - Cross-Sectional Studies
KW - Diabetes Mellitus, Type 2/drug therapy
KW - Female
KW - Glucagon-Like Peptide-1 Receptor/agonists
KW - Glycated Hemoglobin A/analysis
KW - Guideline Adherence/statistics & numerical data
KW - History, 21st Century
KW - Humans
KW - Hypoglycemic Agents/therapeutic use
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Practice Guidelines as Topic/standards
KW - Practice Patterns, Physicians'/history
KW - Registries
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Scotland/epidemiology
KW - Societies, Medical/standards
KW - Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
U2 - 10.2337/dc20-0120
DO - 10.2337/dc20-0120
M3 - Article
C2 - 32581068
SN - 0149-5992
VL - 43
SP - 2034
EP - 2041
JO - Diabetes Care
JF - Diabetes Care
IS - 9
ER -
