Type 2 diabetes medication and HbA1c levels in North Karelia Finland, 2013-2019

Abstract

Aims: To analyse the prevalence of prescribed medications among people with type 2 diabetes, their relationship to HbA1c levels and transitions between medications.

Methods: The data included all 18- to 85-year-old adults with type 2 diabetes (identified from the electronic health records), who lived in North Karelia, Finland, between 2013 and 2019. Type 2 diabetes medication was defined based on prescriptions. Logistic and linear regressions with generalized estimating equations were used to assess the differences between years.

Results: Metformin as a monotherapy was the most used medication (33%-35%) with the largest percentage of those in good glycaemic control. After metformin, the most used medications were long-acting and short-acting insulin and gliptin (16%-24% per group). In insulin groups, there were the smallest percentage of people in good glycaemic control. The use of SGLT2-i increased most during the follow-up (from 1.6% to 11%), but at the same time the percentage of those meeting the target HbA1c level decreased the most (from 83% to 53%). The use of GLP-1 RA and other medications were under 3.5%. SGLT2-i and insulin were the most stable medication groups. The most common transitions were from SGLT2-i to long-acting insulin and between insulin groups.

Conclusions: The sequencing of prescribing additional type 2 diabetes medication or replacing current medication with new ones seems to occur according to guidelines. However, more attention should be paid to the intensification of treatment and the possibilities for new treatment choices in the management of T2D taking into account the persons' characteristics.

Keywords: HbA1c; care; intensification; medicines; treatment; type 2 diabetes.

FIGURE 1

Annual percentages of individuals with type 2 diabetes in each glucose‐lowering medication groups: no medication (black), metformin as a monotherapy (red), gliptins without SGLT2 or GLP‐1 or insulin (green), SGLT2 without GLP‐1 or insulin (blue), GLP‐1 without insulin (light blue), long‐acting insulin without short‐acting insulin (yellow), short‐acting insulin (pink), and other (grey). Each category can include medications from the previous categories except the category other, which includes only medications not mentioned previously. Figure (a) presents the entire study population, (b) 2013 cohort, (c) 2013 cohort with HbA1c < 7% (53 mmol/mol) or (d) 2013 cohort with HbA1c >=7% (53 mmol/mol) at the beginning of follow‐up