OBJECTIVES

Evidence suggests some classes of glucose-lowering medication have cardio-protective benefit, but it remains unclear whether this influences prescribing in the United Kingdom (UK). We aim to describe class level prescribing in people with type 2 diabetes (T2D) by cardiovascular disease (CVD) history using the Clinical Practice Research Datalink (CPRD) (ISAC no.20_061).

METHODS

We identified four cross-sections of people with T2D aged 18-90, and registered with their GP for at least 1 year, on 1^st January 2017, 2018, 2019 or 31^st Dec 2019. Those with evidence of other types of diabetes or pregnancy at the cross-section date were excluded. CVD history and current use of glucose lowering medications per cross-section were assessed by presence of Read-codes and prescription records respectively. Age-standardised proportions and 95% confidence intervals for class use through time were calculated separately by CVD status and total number of medications prescribed (one, two, three, four+).

RESULTS

166,012, 155,290, 152,602 and 145,373 individuals were identified for the respective cross-sections. At each cross-section, 31% had history of CVD. SGLT2 inhibitor use increased in those with CVD through time: 8.0%(95% CI 6.9–9.1%) Jan 2017 to 18.3%(17.0-19.5%) Dec 2019 for dual therapy; 22.7%(21.0-24.4%) to 41.3%(39.5-43.0%) for triple therapy. Similar trends were observed for those without CVD: 9.0%(8.6-9.3%) to 21.2%(20.7-21.7%) and 25.9%(25.2-26.6%) to 45.5%(44.7-46.3%) for dual and triple therapy respectively. GLP1-RA use also increased but estimated usage remained below 17% by end of 2019 for dual and triple therapy. Metformin use remained stable through time; sulfonylurea use declined.

CONCLUSIONS

Use of classes with evidence of cardiovascular benefit has increased, but with little suggestion of CVD history influencing prescribing choice at a population level. There remain a large proportion of people with T2D and CVD not prescribed these classes. Further investigation of factors influencing this finding may highlight opportunities to improve access to optimal evidence based treatment.