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. 2021 Aug 3;44(10):2293-2301.
doi: 10.2337/dc21-0529. Online ahead of print.

Prescribing Trends of Antidiabetes Medications in Patients With Type 2 Diabetes and Diabetic Kidney Disease, a Cohort Study

Samantha T Harris  1   2   3 , Elisabetta Patorno  1   2 , Min Zhuo  1   2   4   5 , Seoyoung C Kim  1   2 , Julie M Paik  6   2   4   7
Affiliations

Prescribing Trends of Antidiabetes Medications in Patients With Type 2 Diabetes and Diabetic Kidney Disease, a Cohort Study

Samantha T Harris et al. Diabetes Care. .

Abstract

Objective: To assess changes in antidiabetes medication class prescriptions over time among patients with diabetic kidney disease (DKD), characteristics of patients prescribed these medications, and prescribers' specialty.

Research design and methods: We conducted a cohort study design using insurance claims data between 2013 and the first quarter of 2020 (2020Q1). Included are adult patients with DKD who initiated a new antidiabetes medication between 2013 and 2020Q1 (N = 160,489 patients). The primary outcome is the yearly and quarterly percent of medication initiation for each antidiabetes medication class over all antidiabetes medication initiations.

Results: For patients with DKD, sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucago-like peptide 1 receptor agonist (GLP-1RA) initiations steadily increased between 2013 and 2020Q1. Internists and endocrinologists were the most frequent prescriber specialties. Patients <65 years of age had a larger percentage of all initiations that were SGLT2i or GLP-1RA, 16% and 23%, respectively, in 2019, and patients >75 years of age had a smaller percentage of all initiations that were SGLT2i or GLP-1RA, 11% and 13%, in 2019.

Conclusions: For patients with DKD, SGLT2i and GLP-1RA prescriptions have increased over time, likely reflecting evolving prescribing patterns in response to the results of recent clinical trials and new clinical guidelines.

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Figures

Figure 1
Figure 1
Medication initiation of antidiabetes medications for patients with DKD over time. Medication class initiations are presented as a percentage of all initiations. Between 2013 and 2018, data are shown aggregated at the year level; 2019 and 2020 data are shown at the quarter level. Quarterly data are available in Supplementary Table 1 for 2013–2018. Major dates shown include the first clinical trials for the class of medications with proven cardiovascular (CV) or renal benefits. Additional dates related to FDA SGLT2i approvals are also included. eGFR units are presented as mL/min/1.73 m2. EMPA-REG, EMPA-REG OUTCOME trial; LEADER, Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results.
Figure 2
Figure 2
Medication initiations as a percentage of all antidiabetes medication initiations by age and calculated eGFR. Between 2013 and 2018, data are shown aggregated at the year level; 2019 and 2020 data are shown at the quarter level. Calculated based on laboratory creatinine values, all eGFR units are mL/min/1.73 m2. Age categories are ≤65 years, 66–74 years, and ≥75 years.
Figure 3
Figure 3
Prescriber specialty for SGLT2i and GLP-1RA initiations over time. Between 2013 and 2018, data are shown aggregated at the year level; 2019 and 2020 data are shown at the quarter level. Internist includes physicians within the following specialties: internal medicine, family medicine, general practice, and hospital medicine. RN/NP/PA, registered nurse/nurse practitioner/physician assistant.
See this image and copyright information in PMC

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