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. 2018 Aug 31;1(4):e00036.
doi: 10.1002/edm2.36. eCollection 2018 Oct.

Different patterns of second-line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): A multinational observational study

Frederik Persson  1 , Johan Bodegard  2 , Jorma T Lahtela  3 , Thomas Nyström  4 , Marit E Jørgensen  1   5 , Majken Linneman Jensen  1 , Hanne L Gulseth  6 , Marcus Thuresson  7 , Fabian Hoti  8 , David Nathanson  4 , Anna Norhammar  9   10 , Kåre I Birkeland  6   11 , Johan G Eriksson  12 , Jan W Eriksson  13
Affiliations

Different patterns of second-line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): A multinational observational study

Frederik Persson et al. Endocrinol Diabetes Metab. .

Abstract

Aims: The understanding of second-line use of glucose-lowering drugs (GLDs) 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-1RA). 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 GLDs (GLP-1RA, 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 GLDs were more commonly used in Finland (92%), Norway (71%) and Denmark (70%) vs Sweden (44%). In 2015, the use of older GLDs (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 GLDs were found. With recent evidence of potential cardiovascular benefits with newer GLDs, such differences may have an important impact on cardiovascular outcomes.

Keywords: SGLT2; observational study; second‐line; type 2 diabetes.

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Figures

Figure 1
Figure 1
Second‐line line initiation after mono‐metformin in the four Nordic countries (Denmark, Finland, Norway and Sweden) during years 2006‐2015
Figure 2
Figure 2
Proportion of second‐line initiation of newer glucose‐lowering drugs (DPP‐4i, SGLT‐2i and GLP1‐RA) in the four Nordic countries (Denmark, Finland, Norway and Sweden) during the year 2015
See this image and copyright information in PMC

References

    1. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient‐centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140‐149. - PubMed
    1. Birkeland KI, Jorgensen ME, Carstensen B, et al. Cardiovascular mortality and morbidity in patients with type 2 diabetes following initiation of sodium‐glucose co‐transporter‐2 inhibitors versus other glucose‐lowering drugs (CVD‐REAL Nordic): a multinational observational analysis. Lancet Diabetes Endocrinol. 2017;5(9):709‐717. - PubMed
    1. Kosiborod M, Cavender MA, Fu AZ, et al. Lower risk of heart failure and death in patients initiated on sodium‐glucose cotransporter‐2 inhibitors versus other glucose‐lowering drugs: the CVD‐REAL Study (comparative effectiveness of cardiovascular outcomes in new users of sodium‐glucose cotransporter‐2 inhibitors). Circulation. 2017;136(3):249‐259. - PMC - PubMed
    1. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with Type 2 diabetes. N Engl J Med. 2016;375(19):1834‐1844. - PubMed
    1. Marso SP, Daniels GH, Brown‐Frandsen K, et al. Liraglutide and cardiovascular outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311‐322. - PMC - PubMed