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Treatment pattern trends of medications for type 2 diabetes in British Columbia, Canada
Greg Carney1,2, Jason D Kim3,2, Cait O'Sullivan3,2
1Therapeutics Initiative, The University of British Columbia, Victoria, British Columbia, Canada Gregory.Carney@ubc.ca.
Introduction:
Several new oral drug classes for type 2 diabetes (T2DM) have been introduced in the last 20 years accompanied by developments in clinical evidence and guidelines. The uptake of new therapies and contemporary use of blood glucose-lowering drugs has not been closely examined in Canada. The objective of this project was to describe these treatment patterns and relate them to changes in provincial practice guidelines.
Research Design And Methods:
We conducted a longitudinal drug utilization study among persons with T2DM aged ≥18 years from 2001 to 2020 in British Columbia (BC), Canada. We used dispensing data from community pharmacies with linkable physician billing and hospital admission records. Laboratory results were available from 2011 onwards. We identified incident users of blood glucose-lowering drugs, then determined sequence patterns of medications dispensed, with stratification by age group, and subgroup analysis for patients with a history of cardiovascular disease.
Results:
Among a cohort of 362 391 patients (mean age 57.7 years old, 53.5% male) treated for non-insulin-dependent diabetes, the proportion who received metformin monotherapy as first-line treatment reached a maximum of 90% in 2009, decreasing to 73% in 2020. The proportion of patients starting two-drug combinations nearly doubled from 3.3% to 6.4%. Sulfonylureas were the preferred class of second-line agents over the course of the study period. In 2020, sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists accounted for 21% and 10% of second-line prescribing, respectively. For patients with baseline glycated hemoglobin (A1C) results prior to initiating diabetic treatment, 41% had a value ≤7.0% and 27% had a value over 8.5%.
Conclusions:
Oral diabetic medication patterns have changed significantly over the last 20 years in BC, primarily in terms of medications used as second-line therapy. Over 40% of patients with available laboratory results initiated T2DM treatment with an A1C value ≤7.0%, with the average A1C value trending lower over the last decade.
Insights
Type 2 diabetes medication patterns in Canada shifted over 20 years, with changes in second-line therapies. Many patients initiated treatment with controlled A1C levels, indicating evolving clinical practice for type 2 diabetes management.
Area of Science:
- Pharmacology
- Endocrinology
- Public Health
Background:
- Over the past two decades, new oral drug classes for type 2 diabetes (T2DM) have emerged, influencing clinical guidelines and treatment approaches.
- Contemporary T2DM treatment patterns and the uptake of these novel therapies in Canada remain under-examined.
Purpose of the Study:
- To describe the evolution of blood glucose-lowering drug utilization in British Columbia (BC) from 2001 to 2020.
- To analyze how these treatment patterns correlate with changes in provincial practice guidelines.
Main Methods:
- A longitudinal drug utilization study was conducted using dispensing data from community pharmacies in BC.
- Data from 362,391 individuals with T2DM were analyzed, including linkage with physician billing and hospital records, with laboratory data available from 2011 onward.
- Medication sequencing was determined, with analyses stratified by age and subgrouped for patients with cardiovascular disease history.
Main Results:
- Metformin monotherapy as first-line treatment decreased from a peak of 90% in 2009 to 73% in 2020.
- The initiation of two-drug combinations nearly doubled (3.3% to 6.4%), with sulfonylureas remaining a common second-line choice.
- In 2020, sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists represented 21% and 10% of second-line prescriptions, respectively.
- Over 40% of patients with available data started T2DM treatment with a glycated hemoglobin (A1C) ≤7.0%, and the average A1C trended lower in the last decade.
Conclusions:
- Significant shifts in oral anti-diabetic medication patterns, particularly for second-line therapies, have occurred in BC over the last 20 years.
- A substantial proportion of patients initiated T2DM treatment with A1C levels ≤7.0%, suggesting improved glycemic control at diagnosis or earlier intervention.
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