Thesis

Drug utilisation patterns and factors influencing prescribing choice of antidiabetic drugs among patients with type 2 diabetes mellitus in Scotland, 2010-2020 : a population-based, multi-study project

Downloadable Content

Download PDF
Creator
Rights statement
Awarding institution
  • University of Strathclyde
Date of award
  • 2023
Thesis identifier
  • T16686
Person Identifier (Local)
  • 201971766
Qualification Level
Qualification Name
Department, School or Faculty
Abstract
  • Introduction: Multiple pharmacological treatment options are currently available for managing type 2 diabetes mellitus (T2DM) with variable safety and extra-glycaemic profiles. However, clinical guidelines mostly do not have a clear treatment algorithm for the optimal selection of antidiabetic drugs (ADDs) as alternative first-line and add-on therapy. Methods: This thesis comprised multiple studies. First, a systematic review and meta-analyses (SRMA) of observational studies investigating factors associated with prescribing ADDs was conducted to identify the gap in this area of research. Second, retrospective cohort studies were performed using linked routinely collected data of patients with T2DM who received ADD between Jan/2010 and Dec/2020 to describe the ADD prescribing patterns and factors influencing ADD prescribing/selection at drug initiation and first-intensification. Data were analysed using descriptive statistics and multinominal logistic regression as appropriate. Results: The identified factors in the SRMA were mapped into four categories; demographic, socioeconomic, clinical, and prescriber factors. Patient age, sex, baseline HbA1c, body mass index (BMI), and kidney problems were the most frequently studied factors. Between 2010 and 2019, 145909 new ADD users with T2DM were identified in Scotland, with around 91% (N=132382) of patients receiving a single ADD. Of those, metformin was the most often prescribed monotherapy (89.7%). Of 145909 new ADD users, 50731 patients were started on metformin (N=46730) or SU (N=4001) monotherapy and intensified with additional ADD(s) between Jan/2010 and Dec/2020. Most initial-metformin (98.4%) and initial-SU users (97.3%) were intensified with single ADD. SU (48.3%) was the most common first intensifying monotherapy after initial metformin but was replaced by SGLT2-I in 2019. Metformin was the most frequently added monotherapy to initial SU (75%). Nevertheless, there was a significant increase in prescribing newer antidiabetic classes (SGLT2-I, DPP4-I), opposite to older ones (SU, insulin, thiazolidinedione). Moreover, multiple clinical (e.g., HbA1c, BMI, etc.) and non-clinical (e.g., age, sex) factors were associated with ADD selection, yet the extent and direction of association varied by antidiabetic class. Conclusions: An overall increase in prescribing newer antidiabetic classes compared to older ones was observed. Some identified factors associated with the prescribing choice were consistent with the variability in drug characteristics, but others (particularly baseline cardiovascular disease) showed inconsistent results.
Advisor / supervisor
  • Mueller, Tanja
  • Kurdi, Amanj
Resource Type
DOI
Funder

Relations

Items

Thumbnail Title Date Uploaded Visibility Actions
file details PDF of thesis T16686 2023-08-30 Public Download