After 2018, according to the report late last year in Diabetes, Obesity & Metabolism, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were more commonly used as second-line agents in the U.S. and the UK, although these agents were not preferentially prescribed among patients with coronary vascular diseases. “Initiation of first-line sulphonylureas was much less common, and most sulphonylurea initiators had metformin added as the second-line agent,” wrote the Brigham and Women’s Hospital and Harvard Medical School–led researchers.
But prescriptions for patients with diabetes go far beyond those for the underlying disease. A new study in the same journal raises concerns about trends in overall prescription medication use among patients with T2D in the U.S.
Using nationally representative data from the National Health and Nutrition Examination Survey from 1999 to 2020 and including adult patients with T2D, Chinese researchers examined the use of prescription drugs, overall and by drug class, polypharmacy defined as the use of five or more medications, and the number of medications attributed to specific classes.
“Increasing trends of polypharmacy were found across all population subgroups and across the majority of therapeutic classes,” the authors pointed out. “Use of non-cardiometabolic medications was common. Among them, the most common were antidepressants (19.8%), proton pump inhibitors (19.0%) and analgesics (16.2%). Among patients with polypharmacy, approximately 40% of medication use was attributed to non-cardiometabolic medications.”
The focus was on the period 2015-2020 and included participants with a mean age of 59.6 years—46.8% (43.6-49.9) were female and 57.8% (52.8-62.8) were non-Hispanic white. “Among 9,489 adults with type 2 diabetes, the prevalence of polypharmacy was high and increased from 35.1% (31.6-38.6) in 1999-2002 to 47.2% (43.7-50.7) in 2003-2006, and further to 51.1% (48.3-53.9) in 2015-2020 (P for trend <0.001),” the researchers advised.
The study concluded that prescription medication burden and complexity increased substantially among patients with T2D, with more than 50% of patients with polypharmacy. “Attention should be paid to this escalating medication use and regimen complexity, which requires multidisciplinary and coordinated care,” the authors recommended.
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