Most Patients Modify Their Type 2 Diabetes Treatment Regimen Within 1 Year of Initiation

Limited data exist on antidiabetic medication (ADM) use patterns following metformin monotherapy failure. Previous research hasn’t thoroughly explored changes, including discontinuation, switching to a new ADM, and intensification of the regimen, from the perspective of patients and clinicians. Predictors of these changes haven’t been adequately examined, and earlier studies largely predate the introduction of newer ADM classes like sodium-glucose cotransporter 2 (SGLT2) inhibitors.

A recent retrospective cohort study published in The American Journal of Managed Care aimed to describe changes in ADM use and identify characteristics associated with modifications after the initiation of noninsulin second-line therapy.

The study utilized private health plan claims for adults with type 2 diabetes who initiated 1 of 5 index ADM classes: sulfonylureas, dipeptidyl peptidase 4 (DPP4) inhibitors, SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or thiazolidinediones. Three treatment modification outcomes—discontinuation, switching, and intensification—were evaluated over a 12-month follow-up period.

Out of the 82,624 adults included in the study, nearly two-thirds (63.6%) experienced some form of treatment modification. Discontinuation was the most common modification, occurring in 38.6% of cases. GLP-1 RAs were associated with the highest discontinuation rate at 50.3%. Switching occurred in 5.2% of patients, while intensification was observed in 19.8%.

Comparative analysis revealed that patients prescribed DPP4 inhibitors had a 7% higher risk of discontinuation compared with those prescribed sulfonylureas, and those prescribed GLP-1 RAs had a 28% higher risk. Additionally, patients taking all other index ADM classes had a higher risk of switching and a lower risk of intensification compared with those taking sulfonylureas. Other factors associated with higher risk of all modifications included younger age and female sex. Patients whose index ADM prescription was written by an endocrinologist had a lower risk of discontinuation and a higher risk of intensification compared with those who received prescriptions from family medicine or internal medicine physicians.

“From the perspective of health plan design and administration,” the investigators wrote, “this study’s outcomes highlight the need to better understand barriers to ADM adherence in the alarmingly large number of patients who discontinued second-line therapy.”