Temporal trends in, and associations of, early-career general practitioner prescriptions of second-line Type 2 Diabetes medications, 2010–2018
by Irena Patsan, Amanda Tapley, Peter Davoren, Alison Fielding, Elizabeth Holliday, Jean Ball, Andrew Davey, Mieke van Driel, Rachel Turner, Katie Mulquiney, Neil Spike, Kristen FitzGerald, Parker Magin
IntroductionSecond-line pharmacotherapy for Type 2 Diabetes Mellitus (‘diabetes’) is necessary for optimal glycaemic control and preventing longer-term complications. We aimed to describe temporal trends in, and associations of, Australian general practitioner (GP) registrars’ prescription, and initiation, of ‘new’ second-line oral agents (dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists) compared to sulphonylureas.
Materials and methodsA longitudinal analysis (2010–2018) of data from the Registrar Clinical Encounters in Training project. Analysis included any diabetes problem/diagnosis that involved prescription of sulphonylureas or ‘new’ oral agents. Simple and multiple logistic regression models were fitted within the generalised estimating equations framework.
Results2333 registrars recorded 6064 diabetes problems/diagnoses (1.4%). 835 problems/diagnoses involved sulphonylurea or ‘new’ medication prescription. Of these, 61.0% [95% CI:57.4–64.4] involved ‘new’ medication prescription. 230 problems/diagnoses involved sulphonylurea or ‘new’ medication initiation, with 77% [95%CI:70.8–82.1] involving a ‘new’ medication. There was a significant 52% per year increase in prescribing (OR = 1.52[95% CI:1.38–1.68],p<0.001), and a 77% per (two-to-three-year) time-interval increase in initiation (OR = 1.77,[95% CI:1.30–2.43],p = <0.001) of ‘new’ medications compared to sulphonylureas. ‘New’ medications were prescribed less for non-English-speaking patients. There was some regional variation in prescribing.
ConclusionRegistrar uptake of ‘new’ oral agents compared to sulphonylureas has increased rapidly.