(122) Personalized Prescribing in Type 2 Diabetes Following The 2015 UK Treatment Guidelines: Description of Non-Insulin Anti-Diabetic Drug (NIAD) Utilization and Polypharmacy Patterns

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1167

Presenting Author(s)

Maria Luisa Marques de Sa Faquetti, MSc
– Swiss Federal Institute of Technology, Zurich, Switzerland

Co-Author(s)

Adrian Martinez-De la Torre
– Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland, Zurich, Z�rich, Switzerland
Theresa Burkard, PhD
– Postdoctoral researcher, ETH Zurich, Zurich, Switzerland
Andrea Burden
– Professor, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland

Background: Metformin remains the recommended first-line non-insulin anti-diabetic drug (NIAD) for type 2 diabetes mellitus (T2DM), however, the implementation of the updated 2015 National Institute for Health and Care Excellence (NICE) guideline in the UK provides opportunity for a more individualized approach when metformin is contraindicated.

Objectives: To identify and quantify common drug combinations in first-time NIAD users with polypharmacy (≥5 co-prescribed drugs) after implementation of the updated 2015 NICE guideline in the UK, stratified by NIAD compound.

Methods: New users of a NIAD aged 18+ were identified from the IQVIA Medical Research Data incorporating data from THIN, A Cegedim Database, between 2016 and 2019. The frequency and proportion of co-prescribed drugs were ranked by frequency of prescribing, stratified by the 5 most prescribed NIAD compounds. The apriori algorithm was applied to identify and quantify drug combinations of up to 7 drugs to investigate potential harmful polypharmacy patterns.

Results: We identified 38,247 new users of NIADs, of which 22,903 had polypharmacy. The most prescribed NIADs in patients with polypharmacy were metformin (n=20,962), followed by gliclazide (n=1,695), linagliptin (n=391), sitagliptin (n=157), and glimepiride (n=105). Linagliptin users were older, more likely to have a history of cardiovascular diseases, and more likely to have kidney impairment when compared to other NIADs. The mean number of co-prescribed drugs was highest among linagliptin users, with 88.5% of patients having polypharmacy. Atorvastatin was the most frequently co-prescribed drug with metformin (38.3%) and linagliptin (36.3%), while metformin was the most co-prescribed drug with sitagliptin (33.1%). Omeprazole was the most co-prescribed drug with the two sulfonylureas (SU), glimepiride (40.0%) and gliclazide (35.4%). We identified several examples of potential DDIs in our study. For example, among gliclazide users, 3.5% additionally received ramipril, bisoprolol, and aspirin, which may potentiate hypoglycemic effects.

Conclusions: While the 2015 NICE guidelines do not provide a preference for second-line treatment, linagliptin appears to be preferentially prescribed among patients with cardiac and kidney diseases. While SU are the preferred second-line NIADs, hypoglycemia and cardiovascular concerns remain. The analysis of drug combinations suggests clinicians should consider polypharmacy when tailoring therapy to avoid potential drug interactions. Following the guideline changes, the potential for confounding by indication may be present, even among new users, and further investigation into harmful polypharmacy is warranted.