Non-insulin Antidiabetic Drugs Research Articles

Real-World Treatment Patterns Among Patients with Type 2 Diabetes Mellitus Initiating Treatment with Oral Semaglutide.

The treatment landscape for type 2 diabetes mellitus (T2DM) is complex and constantly evolving, and real-world evidence of prescribing patterns is limited. The objectives of this study were to characterize lines of therapy (LOTs), calculate the length of time spent on each LOT, and identify the reasons for the LOT end among patients who initiated oral semaglutide for T2DM. This retrospective, claims-based study included commercial and Medicare Advantage adults with T2DM. Data from November 1, 2019, and June 30, 2020, were obtained from Optum Research Database. Patients with ≥ 1 claim for oral semaglutide and continuous health plan enrollment for ≥ 12months prior to (baseline period) and ≥ 6months following (follow-up period) the date of the first oral semaglutide claim were included. LOT 1 began on the date of the first oral semaglutide claim. The start date of any subsequent LOTs was the date of the first claim for an additional non-insulin anti-diabetic drug class or a reduction in drug class with use of commitment medications. The LOT ended at the first instance of medication class discontinuation, change in regimen or end of follow-up. Of the 1937 patients who initiated oral semaglutide, 950 (49.0%) remained on their initial regimen over the 6-month follow-up period, 844 (43.6%) had at least one subsequent LOT, and 89 (4.6%) had at least two subsequent LOTs. Among patients with more than one LOT, approximately 20%-25% used oral semaglutide as monotherapy or combination therapy during LOTs 2 and 3. Metformin was frequently used during treatment across all LOTs. This study provides insight for physicians and payers into the real-world prescribing practices within the first 6months following oral semaglutide initiation and fills the gap in understanding the frequency of regimen changes in the constantly evolving and complex environment of T2DM care.

Application of a data continuity prediction algorithm to an electronic health record-based pharmacoepidemiology study.

Use of algorithms to identify patients with high data-continuity in electronic health records (EHRs) may increase study validity. Practical experience with this approach remains limited. We developed and validated four algorithms to identify patients with high data continuity in an EHR-based data source. Selected algorithms were then applied to a pharmacoepidemiologic study comparing rates of COVID-19 hospitalization in patients exposed to insulin versus noninsulin antidiabetic drugs. A model using a short list of five EHR-derived variables performed as well as more complex models to distinguish high- from low-data continuity patients. Higher data continuity was associated with more accurate ascertainment of key variables. In the pharmacoepidemiologic study, patients with higher data continuity had higher observed rates of the COVID-19 outcome and a large unadjusted association between insulin use and the outcome, but no association after propensity score adjustment. We found that a simple, portable algorithm to predict data continuity gave comparable performance to more complex methods. Use of the algorithm significantly impacted the results of an empirical study, with evidence of more valid results at higher levels of data continuity.

Sodium-glucose cotransporter-2 inhibitors and the risk of atrial fibrillation in patients with type 2 diabetes: a population-based cohort study.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have a direct cardiac effect that is likely to be independent of its glucose lowering renal effect. Previous research has shown that SGLT2-is mitigate heart failure and prevent arrhythmic cardiac death. Our objective is to determine whether SGLT-2is reduce atrial fibrillation (AF) in comparison to other second-to third-line antidiabetic drugs in type 2 diabetes. We conducted a population-based, new-user active comparator cohort study using data from the UK Clinical Practice Research Datalink. We identified a cohort of patients initiating a new antidiabetic drug class between January 2013 and September 2020. This cohort included patients initiating their first ever non-insulin antidiabetic drug, as well as those who switched to or added-on an antidiabetic drug class not previously used in their treatment history. Individuals with a diagnosis of AF or atrial flutter at any time before cohort entry were excluded. Cox regression analysis with time-dependent covariates was used to estimate hazard ratios (HRs) and 95% confidence intervals (95%-CIs) of AF comparing SGLT-2-is with other second-to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥5 years), body mass index (BMI), HbA1c, and presence of heart failure. The cohort comprised 142,447 patients. SGLT-2is were associated with a statistically significant reduced hazard of AF compared to other second-to third-line antidiabetic drugs (adjusted HR:0.77[95%-CI:0.68-0.88]). This reduced risk was present in both sexes but was more prominently among women (adjusted HRwomen:0.60[95%-CI:0.45-0.79]; HRmen:0.85[95%-CI:0.73-0.98]; P-value interaction:0.012). There was no evidence for effect modification when stratifying on duration of diabetes, body mass index, HbA1c, or presence of heart failure. SGLT-2is were associated with a reduced risk of AF in patients with type 2 diabetes compared to other second-to third-line antidiabetic drugs. This reduced risk occurs in both sexes but more prominently among women.

Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population

IntroductionGenetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related...

DiabeText, a mobile health intervention to support medication taking and healthy lifestyle in adults with type 2 diabetes: Study protocol for a randomized controlled trial

AimTo evaluate the effectiveness of DiabeText, a low-intensity, multifaceted, mobile health (mHealth) intervention to support medication taking and lifestyle change targeted to people with type 2 diabetes (T2D). DesignPhase III, 12-months, two-arm (1:1 allocation ratio), randomized parallel-group trial. MethodsWe will recruit 740 adults with glycated hemoglobin (A1c) >8% (>64 mmol/mol) and with at least one prescription of a non-insulin antidiabetic drug. They will be allocated to a control (usual care) group or an intervention (DiabeText messaging intervention) group. The primary outcome measure will be A1c at 12 months follow-up. Secondary outcomes will include medication possession ratio and behavioral and psychological outcomes. DiscussionRecent trials suggest that digital health interventions can effectively support diabetes self-management improving T2D control and reducing important T2D complications. In Spain this type of interventions is understudied. ImpactThis trial will strengthen the evidence base of the impact of mHealth interventions to support diabetes self-management. If effective, DiabeText may offer a low-cost and highly scalable strategy to improve health at the population level in a sustainable way. Trial registrationClinicalTrials.gov identifier NCT05006872; Official Title: Supporting People with Type 2 Diabetes in Effective Use of their Medicine Through a System Comprising Mobile Health Technology Integrated with Clinical Care.

Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report

BackgroundDiabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment.Case presentationA 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves’ disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved.ConclusionIn this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.

Evaluation of outpatient health services in diabetes mellitus in a middle-income setting: a retrospective cohort study involving secondary care

In Brazil, it is necessary to assess the different levels of health care in diabetes mellitus (DM) in order to integrate them. In this retrospective cohort study, we analyzed 1,122 medical records of patients with DM from specialized services with interdisciplinary health teams (IHT) in the city of Ourinhos, São Paulo state, Brazil, to assess the impact of secondary care on glycemic control in patients with DM in those places and to compare baseline and follow-up DM care indicators concerning clinical evaluation and drug treatment regimens in the aforementioned health services. The study covered consultations carried out from September/2013 to September/2017. Data were collected from initial and final appointments in medical records and revealed an increase of 31.21% in insulin introduction and of 73.53% in regimens with three or more non-insulin antidiabetic (NIA) medications. Among the 570 patients with at least two glycated hemoglobin (A1C) measurements in the aforementioned review, 146 did not require any therapeutic adjustment between initial and final appointments, 123 required a subtle adjustment, 95, a moderate adjustment, and 206, an intense adjustment. There was a noticeably higher A1C reduction between initial and final appointments when patients who required an intense drug adjustment were compared to those who did not need any different NIA drug (p-value &lt; 0.0001). In addition to optimizing drug treatment, essential exams in DM were performed with higher frequency, with an increase of 63% in ophthalmology evaluation performed during secondary care approach and 60.65% more individuals being screened for diabetic chronic kidney disease. IHT secondary care considered in this study, therefore, not only improved glycemic control of patients with DM, especially by optimization of NIA regimens and timely prescription of insulin, but also increased the screening for microvascular complications.

71-OR: The Landscape of Pharmacogenetic Variants Associated with Noninsulin Antidiabetic Drugs in the Indian Population

Genetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. India’s distinct genetic architecture and its exploding burden of Type 2 Diabetes (T2D) warrants a population-specific survey of NIAD-associated pharmacogenetic (PGx) variants. We mined 1029 Indian whole genomes for PGx variants, drug-drug (DDI) and drug-drug-gene interactions (DDGI) associated with 44 NIADs. Overall, we found 76 known and 52 predicted deleterious common PGx variants associated with response to T2D therapy among Indians. We report remarkable inter-ethnic differences in the relative cumulative counts of decreased and increased response-associated alleles across NIAD classes. Indians and South Asians showed a significant excess of decreased metformin response-associated alleles compared to other global populations. Network analysis of shared PGx genes predicts high DDI risk during co-administration of NIADs with other metabolic disease drugs. We also predict an increased CYP2C19-mediated DDGI risk for CYP3A4/3A5-metabolized NIADs, saxagliptin, linagliptin and glyburide when co-administered with PPIs. Our findings provide an actionable resource for accelerating future diabetes PGx studies in Indians and reconsidering NIAD dosing guidelines to ensure maximum efficacy and safety in the population. Disclosure A.Sivadas: None. A.Mishra: None. A.Mukhopadhyay: None. K.Narayan: None. S.Sivasubbu: None. V.Scaria: None. A.Kurpad: None. S.Sahana: None. B.Jolly: None. R.C.Bhoyar: None. A.Jain: None. D.Sharma: None. M.Imran: None. V.Senthivel: None. M.K.Divakar: None. Funding DBT/Wellcome Trust India Alliance (IA/E/19/1/504945)

The Association between Diabetes Medication Use and Tumour Characteristics at Diagnosis in Patients with Urothelial Carcinoma: A Retrospective Registry-Based Study1

BACKGROUND: Observational studies indicate a potential association between diabetes medication use and aggressiveness of bladder cancer. OBJECTIVE: The objective is to exploratively study the association between diabetes medication use, as proxy for diabetes, and cancer characteristics of urothelial carcinoma at diagnosis. Furthermore, differences in associations between specific types of diabetes medication are studied. METHODS: The association between use of diabetes medication and urothelial carcinoma (UC) characteristics at diagnosis is studied. A retrospective registry-based study among UC patients in the Netherlands was performed for which two large linked registries from PHARMO and IKNL were used. Patients diagnosed with UC between 2000 and 2016 and no previous cancer were included in this study. In this study, 1,168 UC patients who were diabetes medication users were included as well as 3,609 non-users. Conditional logistic regression analysis was performed to determine odds ratios comparing cancer characteristics between different types of diabetes medication users to non-users. RESULTS: Noninsulin antidiabetic drugs (NIAD) use was associated with a muscle-invasive type of UC compared to non-users (OR = 1.31, 95% CI: 1.10–1.55 for T2+ versus Ta) as well as a poorly differentiated tumour (OR = 1.31, 95% CI: 1.07–1.59 for poorly versus well differentiated tumours). CONCLUSION: Users of diabetes medication are potentially more likely to be diagnosed with a more aggressive tumour than non-users; however, lifestyle factors could not be adjusted for.

The real-world safety profile of sodium-glucose co-transporter-2 inhibitors among older adults (≥ 75 years): a retrospective, pharmacovigilance study

BackgroundAs indications for sodium-glucose co-transporter-2 inhibitors (SGLT2i) are expanding, a growing number of older adults have become candidates for treatment. We studied the safety profile of SGLT2i among older adults.MethodsA retrospective, pharmacovigilance study of the FDA’s global database of safety reports. To assess reporting of pre-specified adverse events following SGLT2i among adults (< 75 years) and older adults (≥ 75), we performed a disproportionality analysis using the sex-adjusted reporting odds ratio (adj.ROR).ResultsWe identified safety reports of 129,795 patients who received non-insulin anti-diabetic drugs (NIAD), including 24,253 who were treated with SGLT2i (median age 60 [IQR: 51–68] years, 2,339 [9.6%] aged ≥ 75 years). Compared to other NIAD, SGLT2i were significantly associated with amputations (adj.ROR = 355.1 [95%CI: 258.8 − 487.3] vs adj.ROR = 250.2 [79.3 − 789.5]), Fournier gangrene (adj.ROR = 45.0 [34.5 − 58.8] vs adj.ROR = 88.0 [27.0 − 286.6]), diabetic ketoacidosis (adj.ROR = 32.3 [30.0 − 34.8] vs adj.ROR = 23.3 [19.2 − 28.3]), genitourinary infections (adj.ROR = 10.3 [9.4 − 11.2] vs adj.ROR = 8.6 [7.2 − 10.3]), nocturia (adj.ROR = 5.5 [3.7 − 8.2] vs adj.ROR = 6.7 [2.8 − 15.7]), dehydration (adj.ROR = 2.5 [2.3 − 2.8] vs adj.ROR = 2.6 [2.1 − 3.3]), and fractures (adj.ROR = 1.7 [1.4 − 2.1] vs adj.ROR = 1.5 [1.02 − 2.1]) in both adults and older adults, respectively. None of these safety signals was significantly greater in older adults (Pinteraction threshold of 0.05). Acute kidney injury was associated with SGLT2i in adults (adj.ROR = 1.97 [1.85 − 2.09]) but not in older adults (adj.ROR = 0.71 [0.59 − 0.84]). Falls, hypotension, and syncope were not associated with SGLT2i among either adults or older adults.ConclusionIn this global post-marketing study, none of the adverse events was reported more frequently among older adults. Our findings provide reassurance regarding SGLT2i treatment in older adults, although careful monitoring is warranted.

What is Glycaemic Variability and which Pharmacological Treatment Options are Effective? A Narrative Review.

Glycated haemoglobin is currently used for diagnosis and follow-up of diabetes mellitus. However, it has important limitations; as it only reflects the average glycaemia over the last 3 months, it does not allow the identification of crucial events, such as episodes of hypoglycaemia and hyperglycaemia. Strict control of hyperglycaemia can result in severe hypoglycaemia that can be life threatening and can have important sequelae. Recently, the concept of glycaemic variability has been developed to provide information about the magnitude of glycaemic excursions and the duration of these fluctuations. This new approach has the potential to improve outcomes, decrease the risk of hypoglycaemia, and decrease cardiovascular risk. This review describes the most commonly prescribed non-insulin anti-diabetic drugs for diabetes management, their mechanism of action, and the existing evidence about their effectiveness in improving glycaemic variability and diabetes control.

CORRELATIONS BETWEEN OLDER PATIENTS’ FIRST COVID-19 VACCINATION TIMING AND MEDICATION ADHERENCE

Abstract Medication adherence and COVID-19 vaccinations are both essential to improving health outcomes and avoiding hospitalizations. When vaccines first became available in early 2021, the CDC recommended prompt vaccination for patients age 65-and-over. Vaccine hesitant older adults are among those at the highest risk for severe outcomes from a COVID-19 infection. A retrospective study was conducted using prescription and vaccine claims data from a pharmacy chain. Patients were included if they: 1) were age 65+ as of 1/1/21; 2) had at least two prescriptions of RAS antagonists, non-insulin anti-diabetics, or statins (in 2021); and 3) received at least two doses of mRNA COVID-19 vaccine between 1/1/21 and 9/21/21. Patients were then split into two evenly-distributed groups based on the number of days into 2021 when they received their first vaccine dose. The outcome was the proportion of optimally adherent patients (PDC ≥ 80%) by condition as of 12/31/21. Two-proportion z-tests were performed comparing the adherent proportions of the “earlier to vaccinate” group versus the “later to vaccinate” group as of 12/31/21. Age groups analyzed were “65-74” and “75+”. The proportion of adherent patients as of 12/31/21 in the “Earlier to Vaccinate” group is higher than those in the “Later to Vaccinate” group for all three adherence metrics by 4.4% (65 to 74) and 2.2% (75+, p=0.00108*) for Diabetes, by 5.1% and 2.6% for Hypertension, and by 6.0% and 3.9% for Statins (*all other p&amp;lt; 0.00001). The timeliness of a patient’s first COVID-19 vaccination dose was predictive of medication adherence in 2021.

Comorbidity clusters associated with newly treated type 2 diabetes mellitus: a Bayesian nonparametric analysis

Type 2 diabetes mellitus (T2DM) is associated with the development of chronic comorbidities, which can lead to high drug utilization and adverse events. We aimed to identify common comorbidity clusters and explore the progression over time in newly treated T2DM patients. The IQVIA Medical Research Data incorporating data from THIN, a Cegedim database of anonymized electronic health records, was used to identify all patients with a first-ever prescription for a non-insulin antidiabetic drug (NIAD) between January 2006 and December 2019. We selected 58 chronic comorbidities of interest and used Bayesian nonparametric models to identify disease clusters and model their progression over time. Among the 175,383 eligible T2DM patients, we identified the 20 most frequent comorbidity clusters, which were comprised of 14 latent features (LFs). Each LF was associated with a primary disease (e.g., 98% of patients in cluster 2, characterized by LF2, had congestive heart failure [CHF]). The presence of certain LFs increased the probability of having another LF active. For example, LF2 (CHF) frequently appeared with LFs related to chronic kidney disease (CKD). Over time, the clusters associated with cardiovascular diseases, such as CHF, progressed rapidly. Moreover, the onset of certain diseases led to further complications. Our models identified established T2DM complications and previously unknown connections, thus, highlighting the potential for Bayesian nonparametric models to characterize complex comorbidity patterns.

Important Decrease in Hospitalizations for Acute Diabetes Events Following FreeStyle Libre System Initiation in People with Type 2 Diabetes on Basal Insulin Therapy in France.

Aims/Hypothesis: Initiation of insulin therapy in people with type 2 diabetes (T2DM) may be necessary to achieve glycemic targets but is associated with acute diabetes events (ADEs), including severe hypoglycemia (SH) or diabetic ketoacidosis (DKA). We assessed the impact of initiating FreeStyle Libre® system (FSL) on hospitalizations for ADEs in people with T2DM on basal insulin only regimen±noninsulin antidiabetic drugs. Materials and Methods: A retrospective study of the French national Système National des Données de Santé reimbursement claims database (≈66 million French people) identified people with T2DM on basal insulin therapy receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. Claims data for the 12 months before, and up to 24 months after FSL initiation, were analyzed. Hospitalizations for ADEs were identified, using ICD-10 codes as main or related diagnosis, for: SH events; DKA events; comas; and hyperglycemia-related admissions. Results: A total of 5933 people with T2DM on basal insulin therapy initiated FSL during the selection period. Of the patients, 78.9% were on basal insulin and other hypoglycemic agents. Among the 5933 patients identified, 2.01% had at least one hospitalization for any ADE in the year before FSL initiation, compared to 0.75% (1 year) and 0.60% (2 years). Reductions in ADEs were driven by 75% fewer DKA admissions, with a 44% reduction in SH admissions. These patterns of reduced ADEs persisted after 2 years, with a further 43% reduction in DKA rates. Conclusions/Interpretation: This study emphasizes the value of the FSL system in reducing ADEs in people with T2DM in France not on intensive insulin therapy and initially treated with basal-only insulin therapy.

Adherence to antidiabetic treatment among patients managed in primary care centres in Spain: the INTENSE study

AimsTo determine the degree and factors related to non-insulin antidiabetic drug (NIAD) adherence in people with type 2 diabetes mellitus (DM2) treated in primary carecentres in Spain. Methods: We did a cross-sectional study. During the study visit, variables related todifferent clinical characteristics, Adherence to Refills and Medications Scale Spanishversion (ARMS-e) and usage of NIAD were collected. We estimated the adherence toNIADs using the proportion of days covered (PDC) equation. Results: In total, 515 participants were included in the study. The mean PDC ratio was70.6 ( ± 28.9), and 50.5% (260) were classified as good adherent (PDC ≥80). Good adherence was highest among users of metformin (67.3%) and lowest among the participants using thiazolidinedione (0.8%). The score for ARMS-e was higher in the poor adherence group. In the multivariable analysis, HbA1c and the use of GLP1-RA or SGLT-2i were negatively associated with good adherence (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.54, 0.82, OR: 0.20, 95%CI: 0.08, 0.46; OR: 0.56, 95%CI: 0.35, 0.89, respectively). Conclusions: Adherence to NIADs observed in our study is far from optimal. HbA1c and ARMS-e items could be used as adherence indicators to encourage treatment changes to improve T2DM control.

The incidence of fractures at various sites in newly treated patients with type 2 diabetes mellitus

PurposeIn this descriptive study, we examined the incidence of fractures in patients with newly treated type 2 diabetes mellitus (T2D) compared to matched reference population. MethodsParticipants from the UK Clinical Practice research datalink (CPRD) GOLD (1987–2017), aged ≥30 years, with a T2D diagnosis code and a first prescription for a non-insulin anti-diabetic drug (n = 124,328) were included. Cases with T2D were matched by year of birth, sex and practice to a reference population (n = 124,328), the mean follow-up was 7.7 years. Crude fracture incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by fracture site and sex and additionally adjusted for BMI, smoking status, alcohol use and history of any fracture at index date. ResultsThe IR of all fractures and major osteoporotic fractures was lower in T2D compared to the reference population (IRR 0.97; 95%CI 0.94–0.99). The IRs were lower for clavicle (IRR 0.67; 0.56–0.80), radius/ulna (IRR 0.81; 0.75–0.86) and vertebral fractures (0.83; 0.75–0.92) and higher for ankle (IRR 1.16; 95%CI 1.06–1.28), foot (1.11; 1.01–1.22), tibia/fibula (1.17; 1.03–1.32) and humerus fractures (1.11; 1.03–1.20). Differences in IRs at various fracture sites between T2D and the reference population were more pronounced in women than in men. In contrast, BMI adjusted IRs for all fractures (IRR 1.07; 1.04–1.10) and most individual fracture sites were significantly higher in T2D, especially in women. ConclusionThe crude incidence of all fractures was marginally lower in patients with newly treated T2D compared to the matched reference population but differed according to fracture site, especially in women. BMI adjusted analyses resulted in higher incidence rates in T2D at almost all fracture sites compared to crude incidence rates and this was more pronounced in women than in men. This implies that BMI may have a protective impact on the crude incidence of fractures, especially in women with newly treated T2D.

Socioeconomic inequalities in insulin initiation among individuals with type 2 diabetes – A quasi-experimental nationwide register study

BackgroundInequalities in access to care can translate to or strengthen existing inequalities in health if people of lower socioeconomic positions do not have equal access to care. I study insulin initiation among individuals with type 2 diabetes and examine whether a reform increasing the co-payment of non-insulin antidiabetics in Finland in 2017 had an inequitable effect on the initiation. In the treatment of type 2 diabetes, insulin is recommended only in later stages and remains covered by the National Health Insurance at a rate of 100%. Data and methodsI evaluated the effect of the reform with Cox proportional hazard modelling using nationwide person-level register data from 2011 to 2019. Exploiting a quasi-experimental design rising from the introduction of the reform allows for consideration of causality. ResultsI found that the risk of insulin initiation was lower in the later years of the study period. Additionally, individuals in lower socioeconomic positions had a higher risk of initiation. However, I did not find inequalities in how the reform affected the risk of insulin initiation between income quintiles. ConclusionsCo-payments are unlikely to be the most influential factor behind persisting inequalities in insulin initiation among individuals with type 2 diabetes in Finland. Lower risk in the later years aligns with developing treatment practices of type 2 diabetes.

Availability of Cardiodiabetological Drugs in Poland during the First Year of COVID-19 Pandemic: Retrospective Study

There were worries that the COVID-19 pandemic could result in a shortage of supplies of some drugs. We aimed to analyze if the COVID-19 pandemic resulted in the availability drop of different cardiodiabetological medicaments. Special attention was put to combined therapies and to investigate the general availability of these drugs. Data were obtained from the Polish startup company GdziePoLek regarding the availability of 121 cardiodiabetolocigal drugs divided into 23 separate categories in Polish pharmacies. The period of the analysis was limited from 1 January 2019 to 31 December 2020. The threshold of a 20% decrease of median availability was set to found drugs with the most severe drop in availability during the COVID-19 pandemic. We also identified medicaments with a median availability of less than 50%. We identified two drugs with the most severe drop in availability level during COVID-19 pandemics: acenocoumarol (decrease by 52.0%) and nitrendipine (decrease by 98.3%). In 2019 and 2020, 27 of 121 drugs had a median availability lower than 50%. The limited availability concerned the most novel agents and polypills, mostly non-insulin antidiabetic drugs. The decrease in drug availability in Poland was not as severe as expected. Accessibility to some novel non-refunded medicaments is limited.

A ten-year study of anti-diabetic drugs utilization in Iran.

According to the world health organization (WHO), by the year 2030 diabetes will become the world's seventh leading cause of death. This study aimed to design and conduct a descriptive pharmacoepidemiological investigation of anti-diabetic drugs utilization during a ten-year period using the anatomical therapeutic classification/defined daily dose (ATC / DDD) system in Iran. Based on pharmaceutical wholesalers' sale reports, sale data, including value and volume, were retrieved from the Iranian Annual Pharma Statistics for 2009-2018. The ATC/DDD system was used to standardize the raw sales data. Anti-diabetic drug utilization was reported as DDD per 1000 person in the population per day. Expenditure was calculated as USD per DDD. Results were then analyzed descriptively. During the ten-year study period, total anti-diabetic drug consumption increased by 235.53%. Insulin utilization grew by 148.65%, whereas non-insulin agents' use showed a 132.68% increase. Anti-diabetic drugs' expenditure increased by almost 9-fold, but changes were accompanied with many fluctuations. Although the absolute expenditure of almost all classes of anti-diabetic drugs were increasing, this growth was greater in biguanides, which only includes metformin in Iran. Approximately one-third of anti-diabetic drugs expenditures were related to fast-acting insulins. Imported drugs share in cost was significant, but not in consumption. The overall share of insulin consumption was less than 19%, but their share of total value reached 60% of the anti-diabetic market. The growing trend in both insulin and non-insulin anti-diabetic drugs utilization is a substantial issue for health authorities' policy making for sustainable access to medicine.

The use of glucose-lowering medications for the treatment of type 2 diabetes mellitus during pregnancy in the United States.

IntroductionSome guidelines allow for the use of either insulin or noninsulin antidiabetic agents for gestational diabetes, but only insulin is recommended for pregnant women with preexisting type 2 diabetes mellitus (T2DM). We aimed to document treatment patterns in routine care for women with preexisting T2DM.MethodsWe identified pregnancy cohorts within 2 US claims databases for publicly and privately insured individuals: the Medicaid Analytical eXtract (2000–2014) and OptumClinformatics (2004–2014). T2DM was classified with a validated algorithm using ICD‐9‐CM and CPT codes. We assessed medication usage over the years of the study, and changes in medication use before and after the beginning of pregnancy, using prescription fills as a proxy for the use of insulin, metformin, sulphonylureas and other noninsulin antidiabetic agents before pregnancy and during each trimester.ResultsAmong 12,631 women with T2DM, insulin use in pregnancy was stable over the study years (55%–60% in the 2nd trimester), but 2nd trimester use of metformin increased from <5% to 20%. Over the study period, 41% of women filled a prescription for metformin before pregnancy, 37% in the 1st trimester and 17% in the 2nd trimester. By the 2nd trimester, few women used sulphonylureas (11%) or other noninsulin antidiabetic agents (1%). Of the women on metformin only before pregnancy, 36% switched to insulin only by 2nd trimester, 11% added insulin and 16% continued on metformin only. Of the women on metformin and insulin before pregnancy, 61% switched to insulin only by 2nd trimester, 22% continued with metformin and insulin and <5% used only metformin.ConclusionThe use of insulin‐metformin combinations and other noninsulin antidiabetic drugs during pregnancy has increased. Safety studies for these medication regimens are needed.