AMBULATORY NON‐INSULIN TREATMENT OF TYPE 2 DIABETES MELLITUS IN THE UNITED STATES, 2015–2019

Importance Tens of millions of individuals in the United States have Type 2 diabetes, and most require treatment with glucose-lowering medications to manage the disease. Objective To examine trends in non-insulin drug treatment of Type 2 diabetes, including first-line and second-line therapies on top of metformin, from 2015 to 2019. Design, setting and participants We conducted a descriptive analysis of cross-sectional data using the IQVIA National Disease and Therapeutic Index (NDTI), a nationally representative audit of ambulatory physician practices in the United States. We focused on the use of non-insulin pharmacologic treatments for Type 2 diabetes among individuals age 35 years and older between January 1st 2015 and December 31st 2019. Main outcome and measures Type 2 diabetes visits where a prescription drug was used ("treatment visit"). Results Ambulatory diabetes visits decreased from 30.1 million (M) treatment visits in 2015 to 29.5 M treatment visits in 2019. Among treatment visits where a single drug was prescribed, use of metformin declined from 57.0% of monotherapy in 2015 to 46.0% of monotherapy in 2019, while during the same period the share of monotherapy accounted for by Glucagon-like peptide -1 (GLP-1) agonists increased from 4.3% to 8.5% and the share accounted for by sodium-glucose cotransporter-2 (SGLT-2) inhibitors increased from 7.3% to 19.5%. Among treatment visits where metformin plus another drug was prescribed, the share of second line therapy accounted for by dipeptidyl peptidase-4 (DPP-4) inhibitors decreased from 21.9% of treatment visits in 2015 to 20.8% of treatment visits in 2019; sulfonylurea use declined from 45.2% to 32.7%, use of SGLT-2 inhibitors increased from 14.5% to 21.2% and use of GLP-1 agonists increased from 9.8% to 18.2%. Conclusions and relevance Significant changes in the landscape of ambulatory care for diabetes have taken place during the past six years, including moderate declines in metformin monotherapy, moderate declines in second-line sulfonylurea use, and large increases in SGLT-2 use. These changes underscore the dynamic nature of drug utilization for diabetes in the United States, and reflect the effects of emerging evidence, evolving clinical guidelines and evolving regulatory and payment policies. This article is protected by copyright. All rights reserved.