Time trends in diabetes medication prescription and factors associated with metformin discontinuation in people with newly diagnosed type 2 diabetes: A national population-based study

Objective To describe, based on the French National Health Insurance (NHI) data, time trends in diabetes medications after treatment initiation in two consecutive cohorts of people newly treated for type 2 diabetes (T2D) in 2008 (1st cohort) and 2013 (2nd cohort). Materials and methods People, aged 45 years and older, newly treated for T2D in 2008 and 2013 were identified in the French NHI Data System. Treatment changes were collected for each year of follow-up. Logistic regression was performed to identify factors associated with metformin discontinuation. Results Respectively, 157 940 and 160 670 beneficiaries (mean age: 63 and 64 years; men proportion: 53 and 52 %) of the French NHI general scheme initiated a diabetes treatment in 2008 and 2013. Metformin was the first monotherapy and increased in use: 67% of monotherapies in 2008 versus 77% in 2013. Monotherapy percentage decreased from the second year onwards in both cohorts. A marked increase of metformin-DPP4i combination therapy was observed (14% of dual therapies in 2008 versus 46% in 2015 in the first cohort), replacing the metformin-sulfonylureas combination as a second-line treatment. Metformin discontinuation was statistically associated with female gender, social deprivation, age, and anti-diabetic polypharmacy. Discontinuation of diabetes treatment was observed after 5-years for, respectively, 10% and 13% in the first and second cohorts. Conclusion Descriptive analysis of 2 consecutive national cohorts showed an evolution in the prescription patterns of anti-diabetic treatments over a short period. With early treatment intensification, increasing rate of metformin monotherapy, and changes in dual-therapy strategy.