Milder Tamara Y, Lin Jialing, Pearson Sallie-Anne, Greenfield Jerry R, Day Richard O, Stocker Sophie L, Neuen Brendon L, Falster Michael O, de Oliveira Costa Juliana
Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Department of Diabetes and Endocrinology, St. Vincent's Hospital, Sydney, Australia.
Br J Clin Pharmacol. 2025 Jan;91(1):117-126. doi: 10.1111/bcp.16231. Epub 2024 Sep 3.
The aim of this study was to examine contemporary trends in the use of, time to, and type of first add-on anti-hyperglycaemic therapy to metformin in Australia.
We used the dispensing records of a 10% random sample of Pharmaceutical Benefits Scheme (PBS) eligible people. We included people aged 40 years and older initiating metformin from 1 January 2018 to 31 December 2020. Our primary outcome was first add-on anti-hyperglycaemic medicine within 2 years of metformin initiation. We analysed time to dispensing of first add-on therapy. All analyses were stratified by metformin initiation year.
Overall, 38 747 people aged 40 years and older initiated metformin between 2018 and 2020. Approximately one-third (n = 12 946) of people received add-on therapy with the proportion increasing slightly by year of metformin initiation (32.3% in 2018 to 34.8% in 2020). Amongst people with add-on therapy following metformin initiation, sodium-glucose cotransporter 2 inhibitor (SGLT2i) use increased from 28.8% (2018) to 35.0% (2020), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) increased from 3.0% to 9.6%, respectively. Dipeptidyl peptidase-4 inhibitors and sulfonylureas as first add-on therapy decreased and insulin remained stable. One-third of people with add-on therapy initiated the therapy on the same day metformin was initiated, i.e. initial combination therapy.
Amongst people initiating metformin from 2018 to 2020, there was an increasing proportion of SGLT2i and GLP-1 RA being used as first add-on therapy. However, the overall prevalence of add-on therapy was low. Advocacy to promote add-on therapy with cardiorenal beneficial medicines is critical to reduce type 2 diabetes morbidity and mortality.
本研究旨在调查澳大利亚二甲双胍首次联合使用的抗高血糖治疗的应用趋势、使用时间及类型。
我们使用了药品福利计划（PBS）符合条件人群10%的随机样本的配药记录。纳入了2018年1月1日至2020年12月31日开始使用二甲双胍的40岁及以上人群。我们的主要结局是在开始使用二甲双胍的2年内首次联合使用的抗高血糖药物。我们分析了首次联合治疗的配药时间。所有分析均按二甲双胍起始年份分层。
总体而言，2018年至2020年期间，38747名40岁及以上人群开始使用二甲双胍。约三分之一（n = 12946）的人接受了联合治疗，联合治疗的比例随二甲双胍起始年份略有增加（2018年为32.3%，2020年为34.8%）。在开始使用二甲双胍后接受联合治疗的人群中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的使用从28.8%（2018年）增加到35.0%（2020年），胰高血糖素样肽-1受体激动剂（GLP-1 RA）从3.0%增加到9.6%。作为首次联合治疗的二肽基肽酶-4抑制剂和磺脲类药物减少，胰岛素使用保持稳定。三分之一接受联合治疗的人在开始使用二甲双胍的同一天开始联合治疗，即初始联合治疗。
在2018年至2020年开始使用二甲双胍的人群中，SGLT2i和GLP-1 RA作为首次联合治疗的比例不断增加。然而，联合治疗的总体患病率较低。倡导使用对心肾有益的药物进行联合治疗对于降低2型糖尿病的发病率和死亡率至关重要。
