Determinants of treatment modification before and after implementation of the updated 2015 NICE guideline on type 2 diabetes: A retrospective cohort study. (June 2021)

• Record Type: Journal Article
• Authors: van Dalem, Judith; Brouwers, Martijn C.G.J.; Burden, Andrea M.; Stehouwer, Coen D.A.; Klungel, Olaf H.; de Vries, Frank; Driessen, Johanna H.M.
• Is Part Of: Diabetes research and clinical practice. Volume 176(2021)
• Publication Date: 2021-06
• Subjects: Diabetes Mellitus Type 2 -- Hypoglycaemic agents -- Drug utilisation -- Sulphonylureas; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2021.108828
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: More diverse prescribing of second-line therapies was observed after 2015. A first step towards individually tailoring prescribing has been made. Not all noteworthy determinants influenced general practitioners' prescribing. Abstract: Aims: To identify patient-specific factors associated with early metformin treatment modification among type 2 diabetes patients before and after implementation of the updated 2015 NICE (National Institute for Health and Care Excellence) guideline. Methods: We conducted a population-based cohort study using data from the Clinical Practice Research Datalink GOLD database (2009–2016). Patients ≥ 18 years, newly treated with metformin only, during the period of valid data collection were included. The first prescription defined start of follow-up. Determinants of treatment modification in two cohorts (before and after implementation of the updated guideline) were studied by time-dependent Cox proportional hazards regression. Results: After implementation of the updated guideline, patients were less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% vs 2.2%) and more likely to receive dipeptidyl peptidase-4 inhibitors (15.8% vs 27.1%) or sodium-glucose cotransporter-2 inhibitors (0.8% vs 9.9%). Some determinants influenced general practitioners' prescribing differently after implementation of the updated guideline compared to before, including a high body mass index and heart failure. Conclusions: Our results indicate that a first step towards tailored prescribing has been made. However, not all determinants that are important to consider when prescribing second-line glucose-lowering agents were of influence on general practitioners' prescribing.