Trends in prescribing preferences for antidiabetic medications among type 2 diabetes patients in the UK with and without chronic kidney disease, 2006-2020

OBJECTIVES: To evaluate trends in antidiabetic medication initiation patterns among type-2 diabetes mellitus (T2DM) patients with and without chronic kidney disease (CKD). 

RESEARCH DESIGN AND METHODS: Retrospective cohort study using the UK Clinical Practice Research Datalink (2006-2020) was conducted to evaluate the overall, first- and second line (after metformin) medication initiation patterns among CKD (N=38,622) and non-CKD (N=230,963) patients with T2DM.  

RESULTS: Relative to other glucose-lowering therapies, metformin initiations declined overall, but remained the treatment of choice as first-line therapy for both CKD and non-CKD patients. Sodium-glucose co-transporter-2 (SGLT2i) use increased modestly among CKD patients, but this increase was more pronounced among non-CKD patients; by 2020, non-CKD compared to CKD patients were three (28.5% vs 9.4%) and six (46.3% vs 7.9%) times more likely to initiate SGLT2i overall and as second-line therapy, respectively. Glucagon like peptide 1 receptor agonist (GLP-1RA) use was minimal regardless of CKD status (<5%), while both dipeptidyl peptidase-4 inhibitor (DPP4i) and sulfonylurea use remained high among CKD patients. For instance, by 2020 and among CKD patients, DPP4i and sulfonylureas comprised of 28.3% and 20.6% of all initiations, and 57.4% and 30.3% of second-line initiations, respectively. 

CONCLUSIONS: SGLT2i use increased among T2DM patients, but this increase was largely driven by non-CKD patients. Future work identifying barriers associated with the uptake of therapies with proven cardiorenal benefits (e.g., SGLT2i, GLP-1RA) among CKD patients is needed.