Characteristics of new users of recent antidiabetic drugs in Canada and the United Kingdom

Vanessa C Brunetti, Audray St-Jean, Sophie Dell'Aniello, Anat Fisher, Oriana H Y Yu, Shawn C Bugden, Jean-Marc Daigle, Nianping Hu, Silvia Alessi-Severini, Baiju R Shah, Paul E Ronksley, Lisa M Lix, Pierre Ernst, Kristian B Filion, Canadian Network for Observational Drug Effect Studies (CNODES) Investigators, Samy Suissa, Colin R Dormuth, Brenda R Hemmelgarn, Jacqueline Quail, Dan Chateau, J Michael Paterson, Jacques LeLorier, Adrian R Levy, Pierre Ernst, Kristian B Filion, Robert W Platt, Ingrid S Sketris, Vanessa C Brunetti, Audray St-Jean, Sophie Dell'Aniello, Anat Fisher, Oriana H Y Yu, Shawn C Bugden, Jean-Marc Daigle, Nianping Hu, Silvia Alessi-Severini, Baiju R Shah, Paul E Ronksley, Lisa M Lix, Pierre Ernst, Kristian B Filion, Canadian Network for Observational Drug Effect Studies (CNODES) Investigators, Samy Suissa, Colin R Dormuth, Brenda R Hemmelgarn, Jacqueline Quail, Dan Chateau, J Michael Paterson, Jacques LeLorier, Adrian R Levy, Pierre Ernst, Kristian B Filion, Robert W Platt, Ingrid S Sketris

Abstract

Background: Characteristics of patients using newer 2nd and 3rd line antidiabetic drugs in a real-world setting are poorly understood. We described the characteristics of new users of sodium-glucose co-transporter-2 inhibitors (SGLT-2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in Canada and the United Kingdom (UK) between 2016 and 2018.

Methods: We conducted a multi-database cohort study using administrative health databases from 7 Canadian provinces and the UK Clinical Practice Research Datalink. We assembled a base cohort of antidiabetic drug users between 2006 and 2018, from which we constructed 3 cohorts of new users of SGLT-2i, DPP-4i, and GLP-1 RA between 2016 and 2018.

Results: Our cohorts included 194,070 new users of DPP-4i, 166,722 new users of SGLT-2i, and 27,719 new users of GLP-1 RA. New users of GLP-1 RA were more likely to be younger (mean ± SD: 56.7 ± 12.2 years) than new users of DPP-4i (67.8 ± 12.3 years) or SGLT-2i (64.4 ± 11.1 years). In Canada, new users of DPP-4i were more likely to have a history of coronary artery disease (22%) than new users of SGLT-2i (20%) or GLP-1 RA (15%).

Conclusion: Although SGLT-2i, DPP-4i, and GLP-1 RAs are recommended as 2nd or 3rd line therapy for type 2 diabetes, important differences exist in the characteristics of users of these drugs. Contrary to existing guidelines, new users of DPP-4i had a higher prevalence of cardiovascular disease at baseline than new users of SGLT2i or GLP-1RA.

Keywords: Type 2 diabetes; dipeptidyl peptidase 4 inhibitors; glucagon-like peptide 1 receptor agonists; sodium-glucose co-transporter 2 inhibitors.

Conflict of interest statement

Dr. Alessi-Severini received research grants from Pfizer and Merck for projects not involving SGLT-2 inhibitors or DPP-4 inhibitors. The remaining authors have no conflicts of interest to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Prevalence of comorbidities at baseline in the Canadian sites. Abbreviations: DPP-4i: dipeptidyl peptidase-4 inhibitors; SGLT-2i: sodium-glucose co-transporter-2 inhibitors; GLP-1 RA: glucagon-like peptide-1 receptor agonists. * Assessed in the 3 years prior to cohort entry

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