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Research

Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

Michelle Greiver, Alys Havard, Juliana Bowles, Sumeet Kalia, Chen Tao, Babak Aliarzadeh, Rahim Moineddin, Julian Sherlock, William Hinton, Frank Sullivan, Braden O'Neill, Conrad Pow, Aashka Bhatt, Fahurrozi Rahman, Bernardo Meza-Torres, Melisa Litchfield and Simon de Lusignan
British Journal of General Practice 4 December 2020; bjgp20X714089. DOI: https://doi.org/10.3399/bjgp20X714089
Michelle Greiver
1 Family and community medicine, North York General Hospital, Toronto, Canada
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  • For correspondence: michelle.greiver@nygh.on.ca
Alys Havard
2 Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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Juliana Bowles
3 School of Computer Sciences, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
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Sumeet Kalia
4 Family and Community Medicine, University of Toronto, Toronto, Canada
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Chen Tao
5 Family and community medicine, North York General Hospital, Toronto, Canada
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Babak Aliarzadeh
6 Family and Community Medicine, University of Toronto, Toronto, Canada
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Rahim Moineddin
7 Family and Community Medicine, University of Toronto, Toronto, Canada
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Julian Sherlock
8 Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom of Great Britain and Northern Ireland
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William Hinton
9 Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom of Great Britain and Northern Ireland
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Frank Sullivan
10 School of Medicine, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
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Braden O'Neill
11 Family and community medicine, North York General Hospital, Toronto, Canada
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Conrad Pow
12 Family and community medicine, North York General Hospital, Toronto, Canada
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Aashka Bhatt
13 Family and Community Medicine, University of Toronto, Toronto, Canada
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Fahurrozi Rahman
14 School of Computer Sciences, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
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Bernardo Meza-Torres
15 Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom of Great Britain and Northern Ireland
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Melisa Litchfield
16 Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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Simon de Lusignan
17 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom of Great Britain and Northern Ireland
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Abstract

Abstract Background: Several new classes of glucose lowering medications have been introduced in the past two decades. Some, such as Sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as Dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake, in order to find ways to support the use of more effective medications. Aims: We studied the uptake of these new classes amongst patients with type 2 diabetes. Design and setting: Retrospective repeated cross-sectional analysis. We compared rates of medication uptake in Australia, Canada, England and Scotland. Method: We used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose-lowering drug class in each year of interest, excluding those on insulin only. We determined proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes. Results: By 2017, data from 238,609 patients were included. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017 more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). Conclusions: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.

  • Clinical (physical)
  • Diabetes
  • Health promotion and prevention
  • Prevention
  • Screening
  • Patient groups
  • Family medicine
  • Related academic disciplines
  • Ethics
  • Received May 29, 2020.
  • Accepted August 24, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)
Michelle Greiver, Alys Havard, Juliana Bowles, Sumeet Kalia, Chen Tao, Babak Aliarzadeh, Rahim Moineddin, Julian Sherlock, William Hinton, Frank Sullivan, Braden O'Neill, Conrad Pow, Aashka Bhatt, Fahurrozi Rahman, Bernardo Meza-Torres, Melisa Litchfield, Simon de Lusignan
British Journal of General Practice 4 December 2020; bjgp20X714089. DOI: 10.3399/bjgp20X714089

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Accepted Manuscript
Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)
Michelle Greiver, Alys Havard, Juliana Bowles, Sumeet Kalia, Chen Tao, Babak Aliarzadeh, Rahim Moineddin, Julian Sherlock, William Hinton, Frank Sullivan, Braden O'Neill, Conrad Pow, Aashka Bhatt, Fahurrozi Rahman, Bernardo Meza-Torres, Melisa Litchfield, Simon de Lusignan
British Journal of General Practice 4 December 2020; bjgp20X714089. DOI: 10.3399/bjgp20X714089
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Keywords

  • Clinical (physical)
  • Diabetes
  • Health promotion and prevention
  • Prevention
  • Screening
  • Patient groups
  • Family medicine
  • Related academic disciplines
  • Ethics

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