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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
- 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.
- Subjects :
- Agonist
Male
medicine.medical_specialty
medicine.drug_class
Nice
030209 endocrinology & metabolism
Type 2 diabetes
Glucagon-Like Peptide-1 Receptor
Body Mass Index
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Hypoglycemic Agents
030212 general & internal medicine
Medical prescription
health care economics and organizations
computer.programming_language
Aged
Retrospective Studies
Glycated Hemoglobin
business.industry
Type 2 Diabetes Mellitus
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
Surgery
Diabetes Mellitus, Type 2
Female
Guideline Adherence
business
Body mass index
computer
Cohort study
Subjects
Details
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....e22d9c27cb5bd25252469abcc7aaeedd
- Full Text :
- https://doi.org/10.6084/m9.figshare.1568645.v1