(85) Changes in Use of Glucose-Lowering Drugs and Physician Responsibility: A Danish Nationwide Study

Publication Number: 416

Background: The landscape of available type 2 diabetes pharmacotherapy has changed dramatically over the last decades.

Objectives: To describe changes in use patterns of glucose-lowering therapy in Denmark during 2005 through 2020.

Methods: Nationwide population-based drug utilization study based on prospective medical databases covering the entire Danish population (~5.8 million). We assessed incident and prevalent glucose-lowering drug use patterns among the 388,676 individuals using at least one non-insulin glucose-lowering drug 2005-2020.

Results: The annual incidence rate of new users of glucose-lowering drugs increased from 2005 (3.9 / 1000 person-years), peaked in 2011 (6.1/1000), and decreased towards 2020 (3.7/1000) to levels comparable to those in 2005. In contrast, the total prevalence of use increased gradually from 2.1% in 2005 to 4.5% of the entire adult population by the end of 2020. By then, metformin comprised 41% of all glucose-lowering drug consumption followed by insulin (20%), glucagon-like peptide 1 receptor agonists (13%), sodium-glucose cotransporter-2 inhibitors (13%), and dipeptidyl peptidase-4 inhibitors (9%). In 2020, 55% of individuals were on monotherapy, 29% used dual therapy while 13% and 2.8% used three and four drug classes, respectively. By 2020, both intensity and diversity of therapies had increased substantially, with 16 different treatment regimens each covering >1% of users, compared to 6 regimens in 2005. In 2020, 89% of all glucose-lowering drugs were prescribed by general practitioners who predominantly prescribed metformin (44% in 2020) followed by insulin (16%) and glucagon-like peptide 1 receptor agonists (12%) while hospital physicians (prescribing 11% of all glucose-lowering drugs) most commonly prescribed insulin (41% in 2020), glucagon-like peptide 1 receptor agonists (19%) and metformin (17%).

Conclusions: While the rate of new users is declining, the total prevalence of use for glucose-lowering drugs continues to increase. The vast majority of glucose-lowering drugs are prescribed by general practitioners and both the intensity and in particular diversity of glucose-lowering treatment is increasing, likely reflecting changing guidelines and increasingly individualized therapy.