Geographic variation in sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist use in people with type 2 diabetes in New South Wales, Australia

Juliana de Oliveira Costa; Jialing Lin; Tamara Y Milder; Jerry R Greenfield; Richard O Day; Sophie L Stocker; Brendon L Neuen; Alys Havard; Sallie-Anne Pearson; Michael O Falster

doi:10.1111/dom.15597

Geographic variation in sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist use in people with type 2 diabetes in New South Wales, Australia

Diabetes Obes Metab. 2024 Apr 15. doi: 10.1111/dom.15597. Online ahead of print.

Authors

Juliana de Oliveira Costa¹, Jialing Lin¹, Tamara Y Milder^{1

2

3

4

5}, Jerry R Greenfield^{2

4

5}, Richard O Day^{3

5}, Sophie L Stocker^{3

6}, Brendon L Neuen^{7

8}, Alys Havard^{1

9}, Sallie-Anne Pearson¹, Michael O Falster¹

Affiliations

¹ Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
² Department of Diabetes and Endocrinology, St. Vincent's Hospital, Sydney, New South Wales, Australia.
³ Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, New South Wales, Australia.
⁴ Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
⁵ School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia.
⁶ School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁷ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
⁸ Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.

PMID: 38618983
DOI: 10.1111/dom.15597

Abstract

Aim: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve glycaemic control and cardio-renal outcomes for people with type 2 diabetes (T2D). However, geographic and socio-economic variation in use is not well understood.

Methods: We identified 367 829 New South Wales residents aged ≥40 years who dispensed metformin in 2020 as a proxy for T2D. We estimated the prevalence of use of other glucose-lowering medicines among people with T2D and the prevalence of SGLT2i and GLP-1RA use among people using concomitant T2D therapy (i.e. metformin + another glucose-lowering medicine). We measured the prevalence by small-level geography, stratified by age group, and characterized by remoteness and socio-economic status.

Results: The prevalence of SGLT2i (29.7%) and GLP-1RA (8.3%) use in people with T2D aged 40-64 increased with geographic remoteness and in areas of greater socio-economic disadvantage, similar to other glucose-lowering medicines. The prevalence of SGLT2i (55.4%) and GLP-1RA (15.4%) among people using concomitant T2D therapy varied across geographic areas, with lower SGLT2i use in more disadvantaged areas and localized areas of high GLP-1RA use (2.5 times the median). Compared with people aged 40-64 years, the prevalence of SGLT2i and GLP-1RA use was lower in older age groups, but with similar patterns of variation across geographic areas.

Conclusions: The prevalence of SGLT2i and GLP-1RA use varied by geography, probably reflecting a combination of system- and prescriber-level factors. Socio-economic variation in GLP-1RA use was overshadowed by localized patterns of prescribing. Continued monitoring of variation can help shape interventions to optimize use among people who would benefit the most.

Keywords: geographic variation; glucagon‐like peptide‐1 receptor agonists; pharmacoepidemiology; sodium‐glucose cotransporter 2 inhibitor; type 2 diabetes.

Grants and funding

105609/WT_/Wellcome Trust/United Kingdom