Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense and Esbjerg, Denmark.
Diabetes Obes Metab. 2024 Nov;26(11):4996-5004. doi: 10.1111/dom.15912. Epub 2024 Sep 16.
To analyse patterns of glucose-lowering therapies among people with type 2 diabetes (T2D) in Denmark from 2016 to 2023.
We examined time trends in the clinical profiles of people with T2D who initiated different glucose-lowering therapy classes for the first time. We furthermore investigated individual-level treatment trajectories following first-ever glucose-lowering therapy in people with or without cardiorenal disease. The study utilized data from the nationwide Danish health registries and included all individuals who filled a first-ever prescription for metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose co-transporter-2 inhibitors (SGLT-2is) or insulin, excluding those without HbA1c-confirmed T2D or probable type 1 diabetes.
We included 260 393 individuals initiating a new glucose-lowering therapy class from 2016 to 2023, during which there were 6- and 3-fold increases in initiators of GLP-1RAs and SGLT-2is, respectively. The median HbA1c level at treatment initiation with GLP-1RAs or SGLT-2is decreased, from 67-68 mmol/mol in 2016-2017 to 57-58 mmol/mol in 2022-2023. Among individuals who initiated metformin as first-line therapy, the proportion who started additional glucose-lowering therapy within 2 years increased from 25% in 2016 to 40% in 2021. Among the 38% of individuals who had established cardiorenal disease when they initiated first-ever glucose-lowering therapy in 2020, 22% used SGLT-2is and 18% GLP-1RAs after 2.5 years, compared with 17% and 21% among initiators without cardiorenal disease, respectively.
Our study documents a trend towards earlier T2D treatment intensification and an increase in the use of GLP-1RAs and SGLT-2is in Denmark. However, optimal T2D treatment is still not received by most individuals with early T2D and established cardiorenal disease.
分析 2016 年至 2023 年丹麦 2 型糖尿病（T2D）患者的降糖治疗模式。
我们研究了首次开始使用不同降糖治疗类别的 T2D 患者的临床特征随时间的变化趋势。我们还调查了在没有或有心血管-肾脏疾病的情况下首次接受降糖治疗后个体的治疗轨迹。该研究利用了全国性的丹麦健康登记数据，包括所有首次开具二甲双胍、二肽基肽酶-4 抑制剂、胰高血糖素样肽-1 受体激动剂（GLP-1RAs）、钠-葡萄糖共转运蛋白-2 抑制剂（SGLT-2is）或胰岛素处方的患者，不包括未经糖化血红蛋白确诊的 T2D 或可能的 1 型糖尿病患者。
我们纳入了 2016 年至 2023 年期间开始新的降糖治疗类别的 260393 名患者，GLP-1RAs 和 SGLT-2is 的起始者分别增加了 6 倍和 3 倍。使用 GLP-1RAs 或 SGLT-2is 起始治疗时的中位糖化血红蛋白水平从 2016-2017 年的 67-68mmol/mol 降至 2022-2023 年的 57-58mmol/mol。在以二甲双胍作为一线治疗的患者中，在 2 年内开始其他降糖治疗的比例从 2016 年的 25%增加到 2021 年的 40%。在 2020 年首次开始使用降糖治疗时已确诊心血管-肾脏疾病的患者中，22%的患者在 2.5 年后使用 SGLT-2is，18%的患者使用 GLP-1RAs，而在无心血管-肾脏疾病的患者中，分别为 17%和 21%。
本研究记录了丹麦 T2D 治疗强化的趋势以及 GLP-1RAs 和 SGLT-2is 使用的增加。然而，大多数早期 T2D 和已确诊心血管-肾脏疾病的患者仍未得到最佳的 T2D 治疗。
