Patterns of initial and first-intensifying antidiabetic drug utilization among patients with type 2 diabetes mellitus in Scotland, 2010-2020: A retrospective population-based cohort study.
Level 3 - non-randomized controlled study
Retrospective population-based cohort study using linked routine healthcare data
PubMed 38558305 · doi:10.1111/dom.15584
What was done
A retrospective cohort study analyzed linked routinely collected health data from Scotland between January 2010 and December 2020. The authors evaluated real-world prescribing patterns and time trends at initial treatment and first intensification in patients with type 2 diabetes mellitus (T2DM).
What was found
Among 145,909 new antidiabetic drug (ADD) users, 90.7% (n = 132,382) received monotherapy at initiation, predominantly metformin (n = 118,737, 89.69%). Overall, 39.40% of patients started on metformin (46,730/118,737; 39.36%) or sulphonylurea (SU; 4,001/10,029; 39.89%) underwent treatment intensification. Sulphonylureas were historically the most common first add-on to metformin (22,197/45,963; 48.29%), but were overtaken by SGLT2 inhibitors in 2019 (33.62% [2,039/6,065] for SGLT2 inhibitors vs. 31.72% [1,924/6,065] for SUs). Across the study window, prescribing shifted significantly toward newer drug classes (SGLT2 inhibitors and DPP-4 inhibitors) and away from older classes (SUs, thiazolidinediones, and insulin).
Why it matters
These findings document a major clinical transition in national real-world practice, capturing the rapid uptake of cardioprotective and nephroprotective SGLT2 inhibitors as preferred second-line agents over sulphonylureas following guideline updates.
Limits
The study relies on retrospective prescription data, which reflects prescribing decisions rather than confirmed patient adherence or clinical rationale (e.g., specific comorbidities or contraindications). Findings from Scotland's single-payer healthcare system may not generalize to systems with different drug formularies, costs, or clinical guidelines. The abstract reports no clinical outcomes such as HbA1c control or adverse events.
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