Trends in the Uptake of SGLT-2 Inhibitors in Type 2 Diabetes Mellitus With Comorbid Cardiovascular Conditions: A Longitudinal Analysis
Moderator
Patrick Muller, MSc, PhD, National Institute for Health and Care Excellence (NICE), London, United Kingdom
Speakers
Jonathan Wray, BSc, PhD, NICE, Manchester, United Kingdom; Muksitur Rahman, United Kingdom; James Hawkins; Lesley Owen, London, United Kingdom
OBJECTIVES: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a class of glucose-lowering therapies increasingly recognised for their cardiorenal protective effects. In 2022, the National Institute for Health and Care Excellence (NICE) updated its guidance to recommend SGLT-2 inhibitors as a first-line treatment for people with type 2 diabetes mellitus (T2DM) and comorbid heart failure (HF) or atherosclerotic cardiovascular disease (aCVD). NICE have also recently published technology appraisals (TAs) recommending SGLT-2 inhibitors for heart failure. We report longitudinal trends in the prescribing of these medicines, and formally evaluate the impact of NICE guidance on prescribing using interrupted time series analyses.
METHODS: Using primary care data from English practices contributing to the Clinical Practice Research Datalink (CPRD) linked with Hospital Episode Statistics (HES), we defined subpopulations of people with T2DM and aCVD or HF. We used a repeated cross-sectional design with monthly intervals between April 2018 and September 2023 to identify current prescriptions. Interrupted time series analyses were used to evaluate the change-in-trend in SGLT-2 inhibitor prescribing before and after publication of the T2DM guideline update and relevant TAs.
RESULTS: The percentage of T2DM patients with a current SGLT-2 inhibitor prescription increased from 6% to 19% between April 2018 and September 2023. The increase was greatest in the sub-population of patients with HF, rising from 3% to 27%. The increase was primarily driven by increased prescribing of dapagliflozin. We found a significant association between publication of the TA (TA679) and increased prescribing of SGLT-2 inhibitors for patients with HF, whilst the 2022 T2DM update was associated with a smaller increase in prescribing.
CONCLUSIONS: Populations covered by a TA experienced a rapid increase in SGLT-2 inhibitor uptake following the TA publication, whereas populations covered only by the guideline saw an increase in uptake of a smaller magnitude.
METHODS: Using primary care data from English practices contributing to the Clinical Practice Research Datalink (CPRD) linked with Hospital Episode Statistics (HES), we defined subpopulations of people with T2DM and aCVD or HF. We used a repeated cross-sectional design with monthly intervals between April 2018 and September 2023 to identify current prescriptions. Interrupted time series analyses were used to evaluate the change-in-trend in SGLT-2 inhibitor prescribing before and after publication of the T2DM guideline update and relevant TAs.
RESULTS: The percentage of T2DM patients with a current SGLT-2 inhibitor prescription increased from 6% to 19% between April 2018 and September 2023. The increase was greatest in the sub-population of patients with HF, rising from 3% to 27%. The increase was primarily driven by increased prescribing of dapagliflozin. We found a significant association between publication of the TA (TA679) and increased prescribing of SGLT-2 inhibitors for patients with HF, whilst the 2022 T2DM update was associated with a smaller increase in prescribing.
CONCLUSIONS: Populations covered by a TA experienced a rapid increase in SGLT-2 inhibitor uptake following the TA publication, whereas populations covered only by the guideline saw an increase in uptake of a smaller magnitude.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD51
Topic
Real World Data & Information Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)