Treatment patterns and associated factors in 14 668 people with type 2 diabetes initiating a second-line therapy: Results from the global DISCOVER study programme.

Antonio Nicolucci, Bernard Charbonnel, Marília B Gomes, Kamlesh Khunti, Mikhail Kosiborod, Marina V Shestakova, Iichiro Shimomura, Hirotaka Watada, Hungta Chen, Javier Cid-Ruzafa, Peter Fenici, Niklas Hammar, Filip Surmont, Fengming Tang, Stuart Pocock

REVIEW


29 October 2019


RELEVANCE 3
INNOVATIVENESS 3
APPLICABILITY 3
OVERALL 3

PAPER DETAILS


TITLE

Treatment patterns and associated factors in 14 668 people with type 2 diabetes initiating a second-line therapy: Results from the global DISCOVER study programme.

ABSTRACT

AIM
To evaluate treatment data from DISCOVER (NCT02322762 and NCT02226822), a global, prospective, observational study programme of patients with type 2 diabetes initiating a second-line glucose-lowering therapy.

MATERIALS AND METHODS
Data were collected using a standardized case report form. First- and second-line treatments were assessed in 14 668 patients from 37 countries across six regions. Among patients prescribed first-line metformin monotherapy, Firth logistic regression models were used to assess factors associated with second-line treatment choices.

RESULTS
The most common first-line therapies were metformin monotherapy (57.9%) and combinations of metformin with a sulphonylurea (14.6%). The most common second-line therapies were combinations of metformin with other agents (72.2%), including dipeptidyl peptidase-4 (DPP-4) inhibitors (25.1%) or sulphonylureas (21.3%). Among patients prescribed first-line metformin monotherapy, the most common second-line therapies were combinations of metformin with a DPP-4 inhibitor [32.8%; across-region range (ARR): 2.4%-51.3%] or a sulphonylurea (30.0%; ARR: 18.3%-63.6%); only a few patients received combinations of metformin with sodium-glucose co-transporter-2 inhibitors (6.7%; ARR: 0.0%-10.8%) or glucagon-like peptide-1 receptor agonists (1.9%; ARR: 0.1%-4.5%). Both clinical and non-medical factors were associated with choice of second-line therapy after metformin monotherapy.

CONCLUSIONS
Fewer patients than expected received metformin monotherapy at first line, and the use of newer therapies at second line was uncommon in some regions of the world. Patients' socioeconomic status was associated with treatment patterns, suggesting that therapy choices are influenced by cost and access.



AUTHOR(S)

Antonio Nicolucci, Bernard Charbonnel, Marília B Gomes, Kamlesh Khunti, Mikhail Kosiborod, Marina V Shestakova, Iichiro Shimomura, Hirotaka Watada, Hungta Chen, Javier Cid-Ruzafa, Peter Fenici, Niklas Hammar, Filip Surmont, Fengming Tang, Stuart Pocock,

JOURNAL

Diabetes, obesity & metabolism

PLACE

England