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.

Keywords: antidiabetic drug; population study; type 2 diabetes.

Conflict of interest statement

A. N., B. C., M. B. G., K. K., M. K., M. V. S., I. S., H. W. and S. P. are members of the DISCOVER Scientific Committee, and received financial support from AstraZeneca to attend DISCOVER planning and update meetings. H. C., P. F. and F. S. are employees of AstraZeneca. N. H. is a former employee of AstraZeneca. J. C.‐R. is an employee of Evidera. In addition, A. N. has received honoraria from Novo Nordisk, Medtronic, AstraZeneca and Eli Lilly, and research support from Novo Nordisk, Sanofi‐Aventis, Artsana and Dexcom; B. C. has received payment from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Takeda; M. B. G. has received payment from Merck‐Serono; K. K. has received payment from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Takeda, Servier and Pfizer, research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Pfizer, and also acknowledges support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care – East Midlands (NIHR CLAHRC – EM) and the National Institute of Health Research (NIHR) Leicester–Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Centre; M. K. has received payment from Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Intarcia, Janssen, Novartis, Novo Nordisk, Glytec Systems, Merck (Diabetes) and Sanofi, and research support from AstraZeneca and Boehringer Ingelheim; M. V. S. has received payment from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Sanofi and Servier, and research support from Novo Nordisk and Sanofi; I. S. has received payment from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Kowa, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanwa Kagaku Kenkyusho and Takeda Pharmaceutical, and research support from Astellas Pharma, AstraZeneca, Daiichi Sankyo, Eli Lilly, Japan Foundation for Applied Enzymology, Japan Science and Technology Agency, Kowa, Kyowa Hakko Kirin, Midori Health Management Center, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanofi, Suzuken Memorial Foundation and Takeda Pharmaceutical; F. T. is an employee of the Mid America Heart Institute and has received research support from AstraZeneca; and H. W. has received payment from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novo Nordisk, Novartis, Ono Pharmaceutical, Sanofi, Sanwa Kagaku Kenkyusho and Takeda, and research support from Abbott, Astellas Pharma, AstraZeneca, Bayer, Benefit One Health Care, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Johnson & Johnson, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nitto Boseki, Novartis, Novo Nordisk, Ono Pharmaceutical, Pfizer, Sanofi, Sanwakagaku Kenkyusho, Taisho Toyama Pharmaceutical, Takeda and Terumo Corp.

© 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

Figure 1

Likelihood of receiving (A) MET and a DPP‐4i, (B) MET and an SGLT‐2i, (C) MET and insulin, and (D) MET and a GLP‐1 RA, compared with receiving MET and an SU in DISCOVER patients who received MET monotherapy as first‐line treatment. Data are presented as odds ratios (95% CI), estimated using Firth multinomial logistic regression models adjusted for all variables in the table.10 BMI, body mass index; CI, confidence interval; DPP‐4i, dipeptidyl peptidase‐4 inhibitor; GLP‐1 RA, glucagon‐like peptide‐1 receptor agonist; MET, metformin; OR, odds ratio; PCP, primary care physician; SGLT‐2i, sodium‐glucose co‐transporter‐2 inhibitor; SU, sulphonylurea. aComposite of nephropathy, retinopathy and neuropathy. bComposite of coronary heart disease, cerebrovascular disease, peripheral artery disease, heart failure and implantable cardioverter defibrillator use. cHypoglycaemic events requiring external/third‐party assistance in the previous year. dHypoglycaemic events that were self‐reported and non‐confirmed, and which occurred in the previous 4 weeks. eOdds ratio was not estimated because none of the patients in Africa received an SGLT‐2i