Title : Type 2 Diabetes Prescriptions by GPs Up 33% in UK
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Type 2 Diabetes Prescriptions by GPs Up 33% in UK
Over the last 5 years, the amount of prescriptions written for diabetes type 2 symptoms medications in England by GPs has risen by 33% — from 26 million to 35 million — as outlined by new figures from data company Exasol.
Overall, for the several years, expenditures of the prescriptions (52%) were for metformin, widely considered to be first-line therapy for type two diabetes worldwide.
And almost 25 percent were still for sulfonylureas, mostly gliclazide — 21% from the GP prescriptions were written because of this latter agent, indicating these older medicine is still trusted as second-line therapy.
This is at line together with the latest NICE guidance for type two diabetes, that has been criticized this past year but has since been somewhat modified. Initially, the UK drugs watchdog recommended sulfonylureas to be used when metformin has stopped being sufficient. But then it amended its final guidance to imply that doctors could now select from sulfonylureas, pioglitazone, and newer agents for instance dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors as second-line therapy.
And these latest figures — which capture every GP prescription dispensed in England from August 2010 to December 2015 — show the newer agents are now used.
There would be a doubling of prescriptions to the DPP-4 inhibitor sitagliptin (Januvia, Merck), as an example — from over 96,000 to in excess of 192,000 in the several years, and overall sitagliptin taken into account 6% of prescriptions, indicating greater using at least two drugs to treat type two diabetes.
Another DPP-4 inhibitor, linagliptin (Tradjenta, Boehringer Ingelheim), landed 2% of prescriptions, while 5% were with the SGLT2 inhibitor dapagliflozin (Forxiga/Farxiga, AstraZeneca).
More Prescriptions Is a "Good-News" Story
Asked to comment, specialist diabetes nurse at Diabetes UK, Libby Dowling, RGN, told Medscape Medical News: "A positive message that individuals can take out of this story is that people are seeing people with diabetes type 2 symptoms getting the treatment how they need, and maybe this is reflecting an increase in awareness — in the people themselves and among GPs — of diabetes type 2 symptoms as a serious condition.
"In the past few years, we've seen several different drugs become offered to treat diabetes," she said, noting that being a result of this, doctors are in possession of many more options, and patients have an overabundance of of an informed choice.
The figures indicate doctors are beginning to prescribe many of these newer agents, she said, along with the hope is the fact GPs "are actually now treating diabetes type 2 symptoms to target and intensely starting to tense up on management from the condition within their patients."
Naresh Kanumilli, MBBS, MRCGP, of Northenden Group Practice, Manchester, United Kingdom — a GP who specializes inside treatment of diabetes — agrees.
"As well as indicating the incidence of diabetes is increasing rapidly, which we all know, these figures demonstrate that GPs say 'Let's handle this more aggressively and attempt to tackle the ailment at an earlier stage,' " he told Medscape Medical News.
However, he warned that early medication use must not come with the expense of lifestyle advice and structured education programs.
"They do go hand-in-hand, and there exists a difference in opinion whether or not we do process, structured education, and lifestyle management on the same time, or do we all do lifestyle and structured education first? And then in the event that fails, head over to medication? Different people feel differently," he observed.
Also, GPs is usually guilty of not properly stressing the significance of nonpharmaceutical approaches, he emphasized.
"GPs are not appearing to promote structured education as being a therapy; it is said, 'You can do that as well' instead of saying, 'Well actually, this really is a vital component of your treatment.' "
Nevertheless, he surmised, "I think this really is good news altogether. One with the things we've had to deal with in the last is inertia — people not doing the right thing in no time, promptly, which ends up in more complications.
"This indicates GPs making the effort to be more aggressive, managing patients sooner in lieu of later, and also the advent of newer drugs has given them a little more confidence, [along with] trials indicating that earlier treatment has long-term benefits," he added.
And the sheer number of brand new therapies for diabetes type 2 means doctors can definitely start to tailor treatment to your individual, added Ms Dowling.
"What Diabetes UK would choose to see is individualization, in order that people visiting their doctors are treated being an individual as opposed to [clinicians] utilizing a blanket approach," she stressed.
GPs Using Newer Drugs They Are Familiar With
Dr Kanumilli declared that GPs just can't keep up as of yet with all the latest research in diabetes type 2 symptoms; instead, they make use of information from local experts.
While rogues will be guiding GPs and saying, " 'If you have to, just extra therapy sooner instead of later, to preserve beta-cell function,' the GPs can be more likely to be just dedicated to HbA1c as well as the target they have to achieve," he explained.
And with regard for the selection of specific new agents, he was quoted saying the data show GPs opting for the drugs these are most knowledgeable about.
"Sitagliptin has been in existence for a long time, individuals have gotten familiar with it and are…comfortable by it [and] together with the side-effect profile."
And dapagliflozin was the initial SGLT2 inhibitor around the market within the United Kingdom, so "again there exists more confidence achievable," he explained, although an alternative SGLT2 inhibitor, empagliflozin (Jardiance, Lilly/Boehringer Ingelheim), has since proven to provide cardiovascular benefit within the large outcomes trial EMPA-REG.
And regarding use — or lack thereof — with the subcutaneously administered glucagonlike peptide 1 (GLP-1) agonists — that are covered beneath the heading "other" to make up 8% with the prescriptions inside report — Dr Kanumilli observed: "This is hit and miss. A lot of people are certainly not keen on injections and examine the next step as insulin and unfairly view insulin because bad guy when actually it does not take best treatment around.
"Some GPs manage to use insulin since the stick to beat people who have — ie, if you can't do this, [you will find yourself on insulin,] which is the wrong move to make," he stressed.
Again, figures for insulin prescribing are covered within the 8% of "other."
Most GPs from the United Kingdom will not likely initiate insulin for type two diabetes, Dr Kanumilli noted: "They will refer visitors to tier 2 facilities or hospitals because of this," but they also will prescribe it when a patient is stabilized into it.
The recent NICE guidance also received fire due to its decision to retain NPH as the 1st-line option for basal insulin for diabetes type 2 symptoms, instead of allowing for usage of newer analogs.
And it absolutely was lukewarm around the GLP-1 agonists, although the second might change from the wake from the positive results in the cardiovascular outcomes trial LEADER, reported trapped on tape with liraglutide (Victoza, Novo Nordisk)
While acknowledging a number of its shortcomings, Ms Dowling concluded that this NICE guidance on diabetes is "an excellent reference point" for GPs for that treatment of diabetes type 2 and "leaves a lot of options accessible to individual clinicians how they will use their particular knowledge to interpret."
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