UNLOCKING REAL-WORLD EVIDENCE THROUGH DATA LINKAGE: OUTCOMES OF CONTEMPORARY GLUCOSE-LOWERING THERAPIES IN OLDER ADULTS IN IRELAND
Author(s)
Arianna Almirall Sanchez, PhD, MD1, Cathal Walsh, Professor2, Roisin Adams, Professor3, Belinda Hernandez, PhD4, Joanne Feeney, PhD5, Caroline Walsh, Professor5, Lea Trela-Larsen, BSc, PhD6, Rose-Anne Kenny, Professor2, Cathal Mc Crory, Professor2, Laura Mc Cullagh, Professor7.
1School of Medicine, Trinity College Dublin/ National Centre for Pharmacoeconomics, Dublin, Ireland, 2Trinity College Dublin, DUBLIN, Ireland, 3National Centre for Pharmacoeconomics/ Trinity College Dublin, Dublin, Ireland, 4National Centre for Pharmacoeconomics/ Trinity College Dublin, DUBLIN, Ireland, 5National Centre for Pharmacoeconomics, DUBLIN, Ireland, 6NCPE Ireland, Dublin, Ireland, 7National Centre for Pharmacoeconomics, Dublin, Ireland.
1School of Medicine, Trinity College Dublin/ National Centre for Pharmacoeconomics, Dublin, Ireland, 2Trinity College Dublin, DUBLIN, Ireland, 3National Centre for Pharmacoeconomics/ Trinity College Dublin, Dublin, Ireland, 4National Centre for Pharmacoeconomics/ Trinity College Dublin, DUBLIN, Ireland, 5National Centre for Pharmacoeconomics, DUBLIN, Ireland, 6NCPE Ireland, Dublin, Ireland, 7National Centre for Pharmacoeconomics, Dublin, Ireland.
OBJECTIVES: Introduction: Type 2 diabetes mellitus management has evolved with the introduction of contemporary glucose-lowering therapies, including GLP-1 receptor agonists, SGLT2 inhibitors, and DPP-4 inhibitors. Real-world effectiveness, treatment persistence, and healthcare utilisation data remains limited. This study aimed to evaluate real-world utilisation outcomes associated with these therapies versus metformin-based treatment in Ireland.
METHODS: Methods: Data from TILDA, a longitudinal cohort study linked to the Primary Care Reimbursement System (PCRS) database (2010-2020), were analysed. Adults aged ≥50 years with evidence of glucose-lowering medication dispensing were included. Participants receiving contemporary therapies were compared with metformin users. Treatment persistence was assessed using Kaplan-Meier analysis. Longitudinal changes in HbA1c, BMI, emergency department (ED) visits, and hospital admissions were evaluated using generalised estimating equations (GEE). Difference-in-differences (DiD) models estimated adjusted between-group effects over time, with multiple imputation for missing data.
RESULTS: Results: The cohort included 120 participants (mean age 67.9 years; 49% female): contemporary therapy users (n=48) and metformin users (n=72). At baseline, contemporary therapy users had higher BMI (32.5 vs 30.4 kg/m²) and high polypharmacy prevalence (>75%). Persistence at 24 months was 47.5% versus 35.6%. Contemporary therapies improved glycaemic control, with HbA1c decreasing from 8.3% to 7.6% versus 8.1% to 7.9%. Adjusted analyses confirmed greater HbA1c reduction (β=-0.30; 95% CI: -0.50 to -0.10; p=0.003), with similar DiD estimates (ratio 0.70; 95% CI: 0.50-1.03). BMI decreased modestly (-0.6 kg/m²; β=-0.20; 95% CI:-0.30 to 0.00; p=0.06). ED visits declined from 0.81 to 0.67/person-year (IRR 0.84; 95% CI 0.71-0.99), while hospital admissions decreased from 0.44 to 0.37/person-year (IRR 0.86; 95% CI 0.72-1.02). Greater benefits were observed among participants aged ≥70 years and those with lower baseline polypharmacy.
CONCLUSIONS: Conclusions: Advanced glucose-lowering therapies were associated with meaningful improvements in glycaemic control and reductions in healthcare utilisation. These findings underscore the value of linked national datasets for generating policy-relevant real-world evidence.
METHODS: Methods: Data from TILDA, a longitudinal cohort study linked to the Primary Care Reimbursement System (PCRS) database (2010-2020), were analysed. Adults aged ≥50 years with evidence of glucose-lowering medication dispensing were included. Participants receiving contemporary therapies were compared with metformin users. Treatment persistence was assessed using Kaplan-Meier analysis. Longitudinal changes in HbA1c, BMI, emergency department (ED) visits, and hospital admissions were evaluated using generalised estimating equations (GEE). Difference-in-differences (DiD) models estimated adjusted between-group effects over time, with multiple imputation for missing data.
RESULTS: Results: The cohort included 120 participants (mean age 67.9 years; 49% female): contemporary therapy users (n=48) and metformin users (n=72). At baseline, contemporary therapy users had higher BMI (32.5 vs 30.4 kg/m²) and high polypharmacy prevalence (>75%). Persistence at 24 months was 47.5% versus 35.6%. Contemporary therapies improved glycaemic control, with HbA1c decreasing from 8.3% to 7.6% versus 8.1% to 7.9%. Adjusted analyses confirmed greater HbA1c reduction (β=-0.30; 95% CI: -0.50 to -0.10; p=0.003), with similar DiD estimates (ratio 0.70; 95% CI: 0.50-1.03). BMI decreased modestly (-0.6 kg/m²; β=-0.20; 95% CI:-0.30 to 0.00; p=0.06). ED visits declined from 0.81 to 0.67/person-year (IRR 0.84; 95% CI 0.71-0.99), while hospital admissions decreased from 0.44 to 0.37/person-year (IRR 0.86; 95% CI 0.72-1.02). Greater benefits were observed among participants aged ≥70 years and those with lower baseline polypharmacy.
CONCLUSIONS: Conclusions: Advanced glucose-lowering therapies were associated with meaningful improvements in glycaemic control and reductions in healthcare utilisation. These findings underscore the value of linked national datasets for generating policy-relevant real-world evidence.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH164
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)