TY - JOUR
T1 - Prescribing Paradigm Shift?
T2 - Applying the 2019 European Society of Cardiology-Led Guidelines on Diabetes, Prediabetes, and Cardiovascular Disease to Assess Eligibility for Sodium-Glucose Cotransporter 2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists as First-Line Monotherapy (or Add-on to Metformin Monotherapy) in Type 2 Diabetes in Scotland
AU - Caparrotta, Thomas M
AU - Blackbourn, Luke A K
AU - McGurnaghan, Stuart J
AU - Chalmers, John
AU - Lindsay, Robert
AU - McCrimmon, Rory
AU - McKnight, John
AU - Wild, Sarah
AU - Petrie, John R
AU - Philip, Sam
AU - McKeigue, Paul M
AU - Webb, David J
AU - Sattar, Naveed
AU - Colhoun, Helen M
AU - Scottish Diabetes Research Network (SDRN) Epidemiology group
N1 - Open Access Policy: https://www.diabetesjournals.org/content/ada-policies-and-procedures-peer-reviewed-publications?survey=1#posting
PY - 2020/9
Y1 - 2020/9
N2 - OBJECTIVE: In 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular (CV) risk management, reflecting recent evidence of CV disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very-high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is.RESEARCH DESIGN AND METHODS: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated.RESULTS: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions.CONCLUSIONS: Thus, 80,830 (30.4%) of all those with T2D (n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration.
AB - OBJECTIVE: In 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular (CV) risk management, reflecting recent evidence of CV disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very-high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is.RESEARCH DESIGN AND METHODS: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated.RESULTS: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions.CONCLUSIONS: Thus, 80,830 (30.4%) of all those with T2D (n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration.
KW - MORTALITY
KW - OUTCOMES
UR - http://www.scopus.com/inward/record.url?scp=85090094237&partnerID=8YFLogxK
U2 - 10.2337/dc20-0120
DO - 10.2337/dc20-0120
M3 - Article
C2 - 32581068
SN - 0149-5992
VL - 43
SP - 2034
EP - 2041
JO - Diabetes Care
JF - Diabetes Care
IS - 9
ER -
