OBJECTIVES: Second-generation antidiabetic medications (including glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose co-transporter-2 (SGLT-2) inhibitors) have shown beyond-antihyperglycemic effects in randomized controlled trials. However, how these medications were prescribed in practice is unknown. This study assessed patient factors associated with use of these medications in a nationally representative sample of patients with type 2 diabetes.

METHODS: This retrospective, cross-sectional analysis used the 2005-2018 National Health and Nutrition Examination Survey (NHANES) data. Survey participants 18 years and older, who were diagnosed with diabetes or ever told having diabetes and have taken any antidiabetic medication in the last 30 days were included. Patients with potential type 1 diabetes, pregnant women, or with non-positive NHANES survey weights were excluded. The primary outcome was the prescription of any second-generation antidiabetic medication. Weighted stepwise multivariable logistic regression models were conducted to assess the associations between use of second-generation antidiabetic medications and patients’ demographics, socioeconomics, access to care, health behaviors, diabetes-related factors, and comorbidities (SAS 9.4 (Carry, NC)).

RESULTS: Among a total of 4,493 (weighted n=19,629,829) type 2 diabetic patients, 533 (weighted %=13.67%) reported using at least one second-generation antidiabetic drug. DPP-4 inhibitors were the most commonly prescribed drug class (n=400, weighted %=70.62%). In multivariable analyses, patients with income of ≥400% poverty level (adjusted odds ratio (aOR)=2.30, 95% confidence interval (CI)=[1.58, 3.34]), higher HbA1c level (aOR=1.10, 95% CI=[1.02, 1.18]), and taking more medications (aOR=1.14, 95% CI=[1.09, 1.20]) were more likely to use second-generation antidiabetic drugs compared to their counterparts.

CONCLUSIONS: We found that the uptake of second-generation antidiabetic medications was low among patients with type 2 diabetes in the United States. Prescription benefit design targeting lower out of pocket payment for these newer drugs may improve patient access and clinical outcomes for patients with type 2 diabetes.