Switching to Versus Addition of Incretin-Based Drugs Among Patients With Type 2 Diabetes Taking Sodium-Glucose Cotransporter-2 Inhibitors

Differential use of antidiabetic medication related to income, cohabitation and area of residence: a Swedish nationwide cohort study

BACKGROUND

Poor adherence to antidiabetic medication in individuals with type 2 diabetes (T2D) may lead to increased risk of morbidity and mortality. Socioeconomic and demographic factors associated with non-adherence have been mainly identified via cross-sectional studies. To investigate the association between antidiabetic medication adherence and income, cohabitation and area of residence.

METHODS

Register-based cohort study of individuals with T2D living in Sweden and initiating antidiabetic treatment between 2006 and 2022. Confounding adjustment and competing events were accounted for via inverse probability of treatment and censoring weighting. Exposures were disposable income, social income support, cohabitation status and area of residence. Outcomes were antidiabetic medication adherence during the first year from treatment initiation and treatment interruption at 12 and 60 months.

RESULTS

This study included 594 918 individuals with T2D. Low disposable income (adjusted OR: 1.18, 95% CI: (1.14 to 1.21)), social income support (1.09, (1.05 to 1.14)), living in large cities (1.28, (1.24 to 1.31)) and cohabitation (1.09, (1.06 to 1.11)) were associated with non-adherence (proportion of days covered ≤0.2), as compared with high adherence (proportion of days covered >0.8). Consistently, treatment interruption was associated with social income support (relative risk ratio at 12 months: 1.10, (1.06 to 1.14) and at 60 months 1.02 (1.00 to 1.05)), living in large cities (1.13, (1.12 to 1.14); 1.08, (1.07 to 1.08)) and low income (1.05, (1.03 to 1.07); 1.01, (1.00 to 1.02)).

CONCLUSIONS

Low income levels, cohabitation and living in large cities were associated with non-adherence to antidiabetic medication and risk of treatment interruption. The results highlight the need for targeted interventions aiming at improving adherence to treatments both at patient and healthcare system levels.

Comparisons of the risks of new-onset prostate cancer in type 2 diabetes mellitus between SGLT2I and DPP4I users: A population-based cohort study

BACKGROUND

Sodium-glucose cotransporter 2 inhibitors (SGLT2I) have been suggested to reduce new-onset cancer amongst type-2 diabetes mellitus (T2DM) patients. This study aims to compare the risks of prostate cancer between SGLT2I and dipeptidyl peptidase-4 inhibitors (DPP4I) amongst T2DM patients.

DESIGN, SETTING AND PARTICIPANTS

This was a retrospective population-based cohort study of prospectively recorded data on male patients with T2DM who were prescribed either SGLT2I or DPP4I between 1st January 2015 and 31st December 2020 from Hong Kong.

METHODS

The primary outcome was new-onset prostate cancer. The secondary outcomes included cancer-related mortality and all-cause mortality. Propensity score matching (1:1 ratio) using the nearest neighbor search was performed and multivariable Cox regression was applied. A three-arm analysis including the glucagon-like peptide-1 receptor agonist (GLP1a) cohort was conducted.

RESULTS

This study included 42129 male T2DM patients (median age: 61.0 years old [SD: 12.2]; SGLT2I: n = 17,120; DPP4I: n = 25,009). In the propensity score matched cohort, the number of prostate cancers was significantly lower in SGLT2I users (n = 60) than in DPP4I (n = 102). Over a follow-up duration of 5.61 years, SGLT2I was associated with lower prostate cancer risks (HR: 0.45; 95% CI: 0.30-0.70) than DPP4I after adjustments. The subgroup analyses showed that the interactions between SGLT2I and age, hypertension, heart failure, and GLP-1a were not statistically significant. The result remained consistent in the sensitivity analysis.

CONCLUSION

The study demonstrated SGLT2I was associated with lower risks of new-onset prostate cancer after propensity score matching and adjustments compared to DPP4I amongst T2DM patients.

Unveiling Diabetes: Categories, Genetics, Diagnostics, Treatments, and Future Horizons

Diabetes mellitus is a global epidemic affecting millions of individuals worldwide. This comprehensive review aims to provide a thorough understanding of the categorization, disease identity, genetic architecture, diagnosis, and treatment of diabetes. The categorization of diabetes is discussed, with a focus on type 1 and type 2 diabetes, as well as the lesser-known types, type 3 and type 4 diabetes. The geographical variation, age, gender, and ethnic differences in the prevalence of type 1 and type 2 diabetes are explored. The impact of disease identity on disease management and the role of autoimmunity in diabetes are examined. The genetic architecture of diabetes, including the interplay between genotype and phenotype, is discussed to enhance our understanding of the underlying mechanisms. The importance of insulin injection sites and the insulin signalling pathway in diabetes management are highlighted. The diagnostic techniques for diabetes are reviewed, along with advancements for improved differentiation between types. Treatment and management approaches, including medications used in diabetes management are presented. Finally, future perspectives are discussed, emphasizing the need for further research and interventions to address the global burden of diabetes. This review serves as a valuable resource for healthcare professionals, researchers, and policymakers, providing insights to develop targeted strategies for the prevention, diagnosis, and management of this complex disease.

Type 2 diabetes

Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.