medwireNews: Geographic remoteness is strongly associated with a reduced likelihood of being prescribed the most recent classes of glucose-lowering medications, find Australian researchers.
“[G]iven Australia’s size, individuals in remote areas are often many hours from healthcare and so continued receipt of older, hypoglycaemia-inducing medications is concerning,” the team writes in Diabetologia.
Metformin was the most commonly prescribed glucose-lowering medication throughout the 2007–2015 study period, followed by sulfonylureas; although use of the latter decreased over time they were not overtaken by newer medications.
The study of 1,203,317 people with type 2 diabetes identified in the Australian National Diabetes Services Scheme also showed a negative impact of low socioeconomic status on the chances of receiving some of the newer medications.
Jedidiah Morton (Baker Heart and Diabetes Institute, Melbourne, Victoria) and co-researchers note that diabetes prevalence is highest and outcomes are worst for people living in the most disadvantaged areas, hence they looked at receipt of medication classes in this group.
They found that glucagon-like peptide (GLP)-1 receptor agonists were significantly less likely to be prescribed to people with low socioeconomic status throughout the study period. For people in the lowest versus the highest quintile, the likelihood was reduced by 35% in the first year and 15% in the last year of the study period.
The chance of receiving dipeptidyl peptidase (DPP)-4 inhibitors was significantly reduced across quintiles of increasing deprivation for the first 2 years of their availability. But this trend disappeared in the third year and reversed in the fourth and subsequent years, with disadvantaged people more likely than affluent people to be given a DDP-4 inhibitor.
Sodium-glucose cotransporter (SGLT)2 inhibitors only became available during the last 2 years of the study period, and there were only small differences in people’s likelihood of receiving them according to their socioeconomic status.
Morton and team say that, in contrast with socioeconomic status, diabetes prevalence in Australia varies only slightly by remoteness. Yet “those in remote areas have twice the diabetes-related hospitalisation rate than people living in major cities,” they note.
The researchers found that people in remote geographic areas were significantly less likely to be prescribed any of the newer medications. Compared with people living in major cities, the chance of being prescribed one of these medications was reduced by 29–54% for DPP-4 inhibitors, 23–54% for GLP-1 receptor agonists, and 29–52% for SGLT2 inhibitors.
Relative to people in major cities, those living in inner regional areas had a significantly reduced likelihood of being prescribed DPP-4 inhibitors and GLP-1 receptor agonists during the first 2 years of their availability. And those in outer regional areas had a significantly reduced likelihood of receiving GLP-1 receptor agonists during the first 2 years and DPP-4 inhibitors at all times, although the difference was small by the end of the study period (4% in the last year).
The researchers found that neither cost, prescriber specialty, nor patient comorbidity completely explained the socioeconomic and geographic differences in use of glucose-lowering medications, which they say “suggests the presence of other unmeasured contributors to the effect of sociodemographic factors on receipt of new medications.”
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Diabetologia 2020; doi:10.1007/s00125-020-05304-3