Pharmacotherapy Personalization May Optimize Outcomes for Type 2 Diabetes

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Patients with CKD were less often prescribed metformin GLP-1 receptor agonists and SGLT2 inhibitors.
Patients with CKD were less often prescribed metformin GLP-1 receptor agonists and SGLT2 inhibitors.

Due to the increasing availability of different medication classes and individual agents, decision-support tools may be useful in pharmacotherapy personalization for individuals with type 2 diabetes (T2D) and ultimately improve outcomes for patients, according to a study published in the Journal of Diabetes and its Complications.

Researchers focused on 228,663 adults with T2D from the Diabetes Collaborative Registry and evaluated areas of interest for pharmacological personalization, dividing the participants into 4 groups: obesity, older age, advanced chronic kidney disease (CKD), and coronary artery disease (CAD). They then examined suboptimal classes of medications for these groups.

In the obesity group, individuals were more likely to be on insulin, thiazolidinediones (TZDs), glucagon-like peptide 1 (GLP-1), receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors and less likely to be on sulfonylureas or dipeptidyl peptidase-4 (DPP4) inhibitors compared with the other groups. This group was also more likely to be on glucose-lowering medications linked to an increased risk of weight gain (obesity I/II: relative risk [RR] 1.02; 95% CI, 1.00–1.03; obesity III: RR 1.09; 95% CI, 1.07–1.11).

In the older age group, individuals were more likely to be on sulfonylureas and TZDs and less likely to be on insulin, metformin, GLP-1 receptor agonists, or SGLT2 inhibitors. This group also showed a higher rate of glucose-lowering medication with a higher rate of hypoglycemia (RR per 5 years: 1.04; 95% CI, 1.04–1.05).

In individuals with CKD, insulin, sulfonylureas, TZDs, and DPP4 inhibitors were more likely to be used than metformin, GLP-1 receptor agonists, and SGLT2 inhibitors. This group also showed a lower rate of T2D medication use with a higher risk for adverse effects (RR 0.74, 95% CI, 0.71–0.77).

Finally, individuals in the CAD group were more likely to be on insulin, metformin, TZDs, and DPP4 inhibitors and were less likely to take sulfonylureas, GLP-1 receptor agonists, and SGLT2 inhibitors. Individuals in this group were not associated with prescriptions for sulfonylurea (RR 0.99; 95% CI, 0.96–1.01).

Researchers conclude that, especially in the case of advanced kidney disease, providers might take the patient factors they analyzed into account when prescribing medications. However, “other factors that might influence treatment decisions—age, obesity, and CAD—did not appear to substantially affect choices of medications.” They also suggest that, going forward, pharmacological personalization may benefit outcomes for patients with T2D.

Disclosures: Multiple authors declare affiliation with several drug companies. Please see reference for a complete list of disclosures.

Reference

Arnold SV, McGuire DK, Inzucchi SE, et al. Assessing use of patient-focused pharmacotherapy in glycemic management through the Diabetes Collaborative Registry (DCR) [published online August 9, 2018]. J Diabetes Complications. doi:10.1016/j.jdiacomp.2018.02.009

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