Ardesch Frank H, Geurten Rose J, Struijs Jeroen N, Ruwaard Dirk, Bilo Henk J G, Elissen Arianne M J
Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Center, the Netherlands.
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Prim Care Diabetes. 2025 Apr;19(2):178-183. doi: 10.1016/j.pcd.2024.12.011. Epub 2025 Jan 14.
This study aims to analyze prescription patterns of new diabetes medication and assess socioeconomic disparities in their initiation among individuals with T2DM with very high cardiovascular risk.
Individuals diagnosed with T2DM and very high cardiovascular risk were identified (N = 10,768) based on general practitioner's electronic health record data. SGLT-2is and GLP-1RAs prescription patterns were examined. Furthermore, the association between SES and the prescription of SGLT-2is and GLP-1RAs in 2022 was investigated.
Despite the increase in prescription rates of SGLT-2is and GLP-1RAs between 2019 and 2022, approximately 85 % and 93 % of eligible individuals did not receive SGLT-2is and GLP-1RAs in 2022, respectively. We found a positive association between SGLT-2is prescription and SES in only the 4th quintile compared to 1st quintile (referent) in the fully adjusted model (OR 1.29 95 % CI:1.08-1.54).
The prescription rates among eligible individuals highlight significant room for improvement in aligning prescribing practices with guidelines. We found no profound socioeconomic gradient in initiation of SGLT-2is and GLP-1RAs. The latter may be due to guidelines' clear indication of the eligible population and GP education. Future development and potential disparities in initiation and maintenance should be monitored to ensure equitable prescribing.
本研究旨在分析新型糖尿病药物的处方模式，并评估心血管风险极高的2型糖尿病患者在起始用药时的社会经济差异。
根据全科医生的电子健康记录数据，确定诊断为2型糖尿病且心血管风险极高的个体（N = 10768）。研究了钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2is）和胰高血糖素样肽-1受体激动剂（GLP-1RAs）的处方模式。此外，还调查了2022年社会经济地位（SES）与SGLT-2is和GLP-1RAs处方之间的关联。
尽管2019年至2022年期间SGLT-2is和GLP-1RAs的处方率有所上升，但2022年分别约有85%和93%的符合条件的个体未接受SGLT-2is和GLP-1RAs治疗。在完全调整模型中，我们发现只有在第4个五分位数与第1个五分位数（参照组）相比时，SGLT-2is处方与SES之间存在正相关（比值比1.29，95%置信区间：1.08 - 1.54）。
符合条件个体的处方率表明，使处方实践与指南保持一致仍有很大的改进空间。我们发现SGLT-2is和GLP-1RAs起始用药方面没有明显的社会经济梯度。后者可能是由于指南对符合条件人群的明确界定以及全科医生教育。应监测未来的发展以及起始用药和维持用药方面的潜在差异以确保公平处方。
