Type 2 Diabetes & Second Line Medication

Many individuals with Type 2 diabetes find it necessary to incorporate a second-line medication alongside metformin, the primary drug for glucose management. However, a recent study from Northwestern Medicine indicates that adherence to these second-line drugs can be inconsistent.

The discontinuation, switching, or intensification of treatment (via increased dosage, adding a third medication, or starting insulin) not only wastes the time of both doctors and patients but also incurs unnecessary expenses for the healthcare system. Moreover, discontinuation can lead to inadequate treatment of Type 2 diabetes.

The study, to be published in the American Journal of Managed Care on Dec. 12, examined over 82,000 patients between 2014 and 2017. Within a year of the initial prescription, nearly two-thirds of patients either stopped their medication, switched to a different drug class, or intensified their treatment.

The analysis covered five non-insulin classes of diabetes medications, revealing that 38% of patients discontinued their medication in four of the five classes. However, among those prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs), half (50%) discontinued treatment.

The study emphasizes the detrimental impact of discontinuation, especially in the case of GLP-1 RAs, where a significant number of patients prescribed this class stopped treatment within a year.

While reasons for discontinuation were not specified, the study suggests that the high discontinuation rate for GLP-1 RAs might be attributed to adverse gastrointestinal side effects. These side effects, such as nausea, vomiting, and diarrhea, are associated with the use of these medications for both diabetes control and weight loss.

Discontinuation of second-line diabetes medication may not immediately lead to hyperglycemia symptoms, but it increases the risk of downstream hospitalizations related to diabetes.

The study also found that the risk of discontinuation was lower and the risk of intensification was higher when an endocrinologist prescribed the medication compared to family medicine or internal medicine physicians. This difference may be due to endocrinologists having expertise in newer diabetes drug classes.

The study underscores the importance of ongoing communication between patients and prescribers, emphasizing the need for discussions about medication benefits, side effects, and costs over time, not just at the time of prescribing.

Full study can be found here.

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