Real-world characteristics, modern antidiabetic treatment patterns, and comorbidities of patients with type 2 diabetes in central and Eastern Europe: retrospective cross-sectional and longitudinal evaluations in the CORDIALLY® study
Jazyk angličtina Země Velká Británie, Anglie Médium electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
36209118
PubMed Central
PMC9548172
DOI
10.1186/s12933-022-01631-4
PII: 10.1186/s12933-022-01631-4
Knihovny.cz E-zdroje
- Klíčová slova
- Cardiovascular disease (CVD), Cardiovascular outcomes trials (CVOTs), Cardiovascular safety, Chronic kidney disease (CKD), Dipeptidyl peptidase-4 inhibitors (DPP4i), Glucagon-like peptide-1 receptor agonists (GLP-1 RA), Glucose-lowering drug, Sodium-glucose cotransporter-2 inhibitors (SGLT2i), Type 2 diabetes,
- MeSH
- benzhydrylové sloučeniny MeSH
- chronická renální insuficience * diagnóza farmakoterapie epidemiologie MeSH
- diabetes mellitus 2. typu * diagnóza farmakoterapie epidemiologie MeSH
- dospělí MeSH
- glifloziny * škodlivé účinky MeSH
- glukagonu podobný peptid 1 terapeutické užití MeSH
- glukosidy MeSH
- hypoglykemika škodlivé účinky MeSH
- kardiovaskulární nemoci * diagnóza epidemiologie prevence a kontrola MeSH
- lidé MeSH
- průřezové studie MeSH
- receptor pro glukagonu podobný peptid 1 MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- benzhydrylové sloučeniny MeSH
- empagliflozin MeSH Prohlížeč
- glifloziny * MeSH
- glukagonu podobný peptid 1 MeSH
- glukosidy MeSH
- hypoglykemika MeSH
- receptor pro glukagonu podobný peptid 1 MeSH
BACKGROUND: Guidelines from 2016 onwards recommend early use of SGLT2i or GLP-1 RA for patients with type 2 diabetes (T2D) and cardiovascular disease (CVD), to reduce CV events and mortality. Many eligible patients are not treated accordingly, although data are lacking for Central and Eastern Europe (CEE). METHODS: The CORDIALLY non-interventional study evaluated the real-world characteristics, modern antidiabetic treatment patterns, and the prevalence of CVD and chronic kidney disease (CKD) in adults with T2D at nonhospital-based practices in CEE. Data were retrospectively collated by medical chart review for patients initiating empagliflozin, another SGLT2i, DPP4i, or GLP-1 RA in autumn 2018. All data were analysed cross-sectionally, except for discontinuations assessed 1 year ± 2 months after initiation. RESULTS: Patients (N = 4055) were enrolled by diabetologists (56.7%), endocrinologists (40.7%), or cardiologists (2.5%). Empagliflozin (48.5%) was the most prescribed medication among SGLT2i, DPP4i, and GLP-1 RA; > 3 times more patients were prescribed empagliflozin than other SGLT2i (10 times more by cardiologists). Overall, 36.6% of patients had diagnosed CVD. Despite guidelines recommending SGLT2i or GLP-1 RA, 26.8% of patients with CVD received DPP4i. Patients initiating DPP4i were older (mean 66.4 years) than with SGLT2i (62.4 years) or GLP-1 RA (58.3 years). CKD prevalence differed by physician assessment (14.5%) or based on eGFR and UACR (27.9%). Many patients with CKD (≥ 41%) received DPP4i, despite guidelines recommending SGLT2is owing to their renal benefits. 1 year ± 2-months after initiation, 10.0% (7.9-12.3%) of patients had discontinued study medication: 23.7-45.0% due to 'financial burden of co-payment', 0-1.9% due to adverse events (no patients discontinued DPP4i due to adverse events). Treatment guidelines were 'highly relevant' for a greater proportion of cardiologists (79.4%) and endocrinologists (72.9%) than diabetologists (56.9%), and ≤ 20% of physicians consulted other physicians when choosing and discontinuing treatments. CONCLUSIONS: In CORDIALLY, significant proportions of patients with T2D and CVD/CKD who initiated modern antidiabetic medication in CEE in autumn 2018 were not treated with cardioprotective T2D medications. Use of DPP4i instead of SGLT2i or GLP-1 RA may be related to lack of affordable access, the perceived safety of these medications, lack of adherence to the latest treatment guidelines, and lack of collaboration between physicians. Thus, many patients with T2D and comorbidities may develop preventable complications or die prematurely. Trial registration NCT03807440.
3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Czech Republic
Boehringer Ingelheim RCV GmbH and Co KG Vienna Austria
Clinic of Endocrinology University Hospital Alexandrovska Sofia Bulgaria
Department of Internal Medicine Medical University Sofia Sofia Bulgaria
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ClinicalTrials.gov
NCT03807440