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Adherence to NICE guidance on glucagon-like peptide-1 receptor agonists among patients with type 2 diabetes mellitus: an evaluation using the Clinical Practice Research Datalink

Authors :
K. Jameson
Paul Leigh
Kalpana D’Oca
Tarita Murray-Thomas
Publication Year :
2015
Publisher :
Taylor & Francis, 2015.

Abstract

Aims: To assess adherence to the United Kingdom’s (UK) National Institute for Health and Care Excellence (NICE) guidelines for initiating and continuing glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes (T2DM).Research Design & Methods: A retrospective cohort study of 7,133 primary care patients ≥40 years with a first prescription for GLP-1 receptor agonist following publication of NICE guideline/guidance. Patient characteristics and levels of clinical monitoring were assessed using descriptive analyses.Main outcome measures: Main outcomes were the proportion of patients initiating GLP-1 receptor agonist as part of NICE recommended dual- or triple-therapy regimens; the proportions meeting NICE triple therapy initiation criteria (glycosylated haemoglobin [HbA1c] ≥7.5% and body mass index [BMI] ≥35kg/m2) and the proportions continuing GLP-1 receptor agonist at 6 months according to NICE recommendations.Results: Mean age at initiating GLP-1 receptor agonist was 58.2 years (SD 9.4), BMI 38.4 kg/m2 (SD 6.8) and HbA1c 9.2% (SD 3.2%). Overall, only 25% of patients initiated GLP-1 receptor agonist as part of a NICE-recommended regimen. Of patients initiated on a recommended triple-therapy regimen, 50% (646/1284) fulfilled both NICE HbA1c and BMI initiation criteria. Approximately 18% (32/174) of patients continuing NICE-recommended dual-therapy at 6 months achieved a 1% reduction in HbA1c and 6.4% (33/515) continuing with NICE recommended triple-therapy achieved both NICE’s target reductions for HbA1c and body weight. About 8% of patients continuing exenatide as triple therapy (N=243) achieved both targets.Conclusions: Adherence to NICE guidance for initiating and continuing GLP-1 receptor agonists is low. However, lack of data on ethnicity (for assessing NICE’s BMI criteria) and on contraindications and/or hypersensitivity to other diabetes medication in the treatment pathway have limited our ability to fully assess adherence to GLP-1 prescribing.Further research is warranted to better understand general practitioners prescribing decisions given the cost of prescribing GLP-receptor agonists.

Details

Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....e22d9c27cb5bd25252469abcc7aaeedd
Full Text :
https://doi.org/10.6084/m9.figshare.1568645.v1