medwireNews: The most recently approved class of glucose-lowering medication may not be reaching people with additional health conditions who would particularly benefit from these medications, a study of over a million US patients with diabetes suggests.
Sodium-glucose cotransporter (SGLT)-2 inhibitors have shown cardiovascular and renal benefits beyond their glucose-lowering abilities and a low risk of hypoglycemia, and are the preferred second-line medications for people at risk for these outcomes in the recent ADA/EASD hyperglycemia guidelines. Yet researchers found that patients with heart failure, myocardial infarction, kidney disease, and prior hypoglycemia were significantly less likely than others to be prescribed these agents between 2013 and 2016.
The study of medical and pharmacy claims from 1,054,727 people with diabetes during this period also revealed that younger, healthier patients with commercial health insurance and those who were not Black were significantly more likely than others to begin taking an SGLT2 inhibitor.
The participants, who all had pharmacologically treated type 1 or type 2 diabetes, were part of a large, private US health plan and were either privately insured or had Medicare Advantage coverage.
Overall, 7.2% (75,500) were treated with an SGLT2 inhibitor and seven in every 10 receiving these agents were taking canagliflozin.
Rozalina McCoy (Mayo Clinic, Rochester, Minnesota, USA) and colleagues report that patients with prior myocardial infarction were a significant 6% less likely than those without to be prescribed an SGLT2 inhibitor during the study period.
Similarly, those with heart failure were 7% less likely than other patients to receive this drug class, while patients with kidney disease were 20% less likely than others to receive these agents.
Patients with previous severe hypoglycemia were 4% less likely than others to receive SGLT2 inhibitors and those with prior hyperglycemic events were also a significant 5% less likely than those without to receive them, after adjusting for other concurrent glucose-lowering therapies, including insulin.
Conversely, patients with hypertension were 10% more likely to be treated with an SGLT2 inhibitor than those with normal blood pressure.
Patients aged at least 75 years were 43% less likely than those aged 18 to 44 years to begin SGLT2 inhibitors, while Black patients were 7% less likely than White patients to receive them, and patients with Medicare Advantage insurance were 37% less likely to receive them versus those with commercial insurance.
Reporting in Diabetes Technology & Therapeutics, the researchers add that “while SGLT2 [inhibitors] are approved and guideline recommended as second-line agents for the management of type 2 diabetes, they were commonly prescribed as first-line agents and occasionally used by patients with type 1 diabetes.”
By Anita Chakraverty
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
Diabetes Technol Ther 2019; doi:10.1089/dia.2019.0213