Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Institute for Global Health and Development, Peking University, Beijing, China.
Diabetes Care. 2022 Dec 1;45(12):2926-2934. doi: 10.2337/dc22-1253.
To characterize and compare glucose-lowering medication use in type 2 diabetes in the U.S., Sweden, and Israel, including adoption of newer medications and prescribing patterns.
We used data from the National Health and Nutrition Examination Survey (NHANES) from the U.S., the Stockholm CREAtinine Measurements (SCREAM) project from Sweden, and Maccabi Healthcare Services (Maccabi) from Israel. Specific pharmacotherapy for type 2 diabetes between 2007 and 2018 was examined.
Use of glucose-lowering medications among patients with type 2 diabetes was substantially lower in NHANES and SCREAM than in Maccabi (66.0% in NHANES, 68.4% in SCREAM, and 88.1% in Maccabi in 2017-2018). Among patients who took at least one glucose-lowering medication in 2017-2018, metformin use was also lower in NHANES and SCREAM (74.1% in NHANES, 75.9% in SCREAM, and 92.6% in Maccabi) whereas sulfonylureas use was greater in NHANES (31.5% in NHANES, 16.0% in SCREAM, and 14.9% in Maccabi). Adoption of dipeptidyl peptidase 4 inhibitors and sodium-glucose cotransporter 2 inhibitors (SGLT2i) was slower in NHANES and SCREAM than in Maccabi. History of atherosclerotic cardiovascular disease, heart failure, reduced kidney function, or albuminuria was not consistently associated with greater use of SGLT2i or glucagon-like peptide 1 receptor agonists (GLP1RA) across the three countries.
There were substantial differences in real-world use of glucose-lowering medications across the U.S., Sweden, and Israel, with more optimal pharmacologic management in Israel. Variation in access to care and medication cost across countries may have contributed to these differences. SGLT2i and GLP1RA use in patients at high risk was limited in all three countries during this time period.
描述并比较美国、瑞典和以色列 2 型糖尿病患者的降糖药物使用情况，包括新型药物的采用情况和处方模式。
我们使用了来自美国国家健康和营养调查（NHANES）、瑞典斯德哥尔摩 CREAtinine Measurements（SCREAM）项目和以色列马卡比医疗保健服务（Maccabi）的数据。研究了 2007 年至 2018 年期间 2 型糖尿病的具体药物治疗情况。
在 NHANES 和 SCREAM 中，2 型糖尿病患者使用降糖药物的比例明显低于 Maccabi（2017-2018 年分别为 66.0%、68.4%和 88.1%）。在 2017-2018 年至少服用一种降糖药物的患者中，二甲双胍的使用率在 NHANES 和 SCREAM 中也较低（分别为 74.1%、75.9%和 92.6%），而磺脲类药物的使用率在 NHANES 中较高（分别为 31.5%、16.0%和 14.9%）。在 NHANES 和 SCREAM 中，二肽基肽酶 4 抑制剂和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）的采用速度较慢，而在 Maccabi 中则较快。在这三个国家中，动脉粥样硬化性心血管疾病、心力衰竭、肾功能降低或白蛋白尿的病史与 SGLT2i 或胰高血糖素样肽 1 受体激动剂（GLP1RA）的使用增加并不一致。
在美国、瑞典和以色列，真实世界中使用的降糖药物存在很大差异，以色列的药物治疗更为优化。各国之间在获得医疗服务和药物费用方面的差异可能导致了这些差异。在这段时间内，所有三个国家中高风险患者的 SGLT2i 和 GLP1RA 使用率都受到限制。
