Prescribing paradigm shift? Applying the 2019 European Society of Cardiology-led guidelines on ‘diabetes, pre-diabetes, and cardiovascular disease’ to assess eligibility for sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists as first-line monotherapy (or add-on to metformin monotherapy) in type 2 diabetes in Scotland
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Research Design and Methods: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, employing variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to those drug-naïve or metformin monotherapy people and the anticipated prescribing change calculated.
Results: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of T2D) were drug-naïve and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4% respectively were estimated as at least high risk given the guideline risk definitions.
Conclusion: Thus, 80,830 (30.4%) of all those with T2D (n=265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring and the trade-off with reduced CVD-related healthcare costs will need careful consideration.