March 09, 2021
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SGLT2 inhibitors offer limited glycemic management benefits and may not be cost-effective for most people with type 2 diabetes, according to a study published in the Journal of Diabetes and Its Complications.
“This study examined prescribing trends before publishing scientific evidence of its benefit in some patients with heart failure and progressive kidney disease.” Larry A. Weinrauch, MD, a clinical researcher at Joslin Diabetes Center and a part-time assistant professor at Harvard Medical School, said Healio. “Our study documented the changes in prescribing patterns and found no significant improvements in glycemic control associated with the availability of the newer drugs.”
Wine smoke is a clinical researcher at the Joslin Diabetes Center and part-time assistant professor at Harvard Medical School.
Weinrauch and colleagues performed a retrospective review of all patients diagnosed with type 2 diabetes and high blood pressure who had at least two visits to the Joslin Diabetes Center from 2010 to 2012 and 2014 to 2016. Demographic information, BMI, HbA1c, estimated glomerular filtration rate, blood pressure, smoking status, and full drug lists were obtained. The researchers compared the use and effects of drugs from the first period before SGLT2 inhibitors were approved in the US and the second period after the drugs were approved for the treatment of type 2 diabetes.
Of 10,191 people included in the analysis, 7,769 had data from 2010 to 2012 and 6,576 had at least one visit from 2014 to 2016. Compared to the period 2010-2012, there was a decrease in the use of biguanides in 2014-2016 (69, 5%) 66.3%), sulfonylurea compounds (44.7% vs. 39.4%), thiazolidinediones (13.6% vs. 3.4%), amylin analogs (2.7% vs. 1.1%) , Meglitinide (3.9% vs. 2.5%) and thiazide diuretics (32.4% vs. 28.9%), while the use of GLP-1 receptor agonists (16% vs. 23.8%), SGLT2 inhibitors (0% versus 14%) and insulin (56.1% versus 60.5%) increased. and statins (78.4% versus 81.5%).
Compared to 2010-2012, the study cohort had a slight decrease in HbA1c (7.9% versus 7.8%), BMI (32.5 kg / m2vs. 32.1 kg / m2) and eGFR (80, 6 ml per minute versus 77.5 ml per minute) 2014-2016. There was also a slight increase in systolic blood pressure from 2010-2012 to 2014-2016 (130 mm Hg versus 132 mm Hg).
“Based on our reviews of current US pricing, the monthly cost of high-dose metformin and glipizide are both less than $ 30, compared to more than $ 300 for liraglutide (Saxenda, Novo Nordisk) and more than $ 450 for empagliflozin (Jardiance, Boehringer Ingelheim) and Eli Lilly), ”wrote the researchers. “That 10 to 15-fold increase in monthly blood sugar control costs was associated with a decrease in HbA1c from 7.9% to 7.8% in our study.”
According to Weinrauch, it is important for the consumer to compare the cost-effectiveness of SGLT2 inhibitors with the potential benefits in people with type 2 diabetes and high blood pressure.
“Guidelines for the treatment of diabetes are written based on science by clinicians for clinicians, by insurers for payers, but not for the working people who have to pay for health insurance, copays and medication,” said Weinrauch. “These consumers / patients have a different value system that is not based on the significant differences in the combined endpoints. Your question is always based on “what will this do for me?” The patients in our study were already taking pills for high blood pressure and cholesterol, and 70% were taking two or more drugs to control blood sugar. “
Weinrauch said longer-term data are needed to assess whether SGLT2 inhibitors or GLP-1 receptor antagonists have glucose control benefits over cheaper drugs. He added that future research should look at cost comparisons rather than cost-effectiveness.
“We need to know what benefits we are buying for whom, and at what price, to understand that in patients with heart failure, the potential benefits can be worth the additional cost.” Said Weinrauch.
For more informations:
Larry A. Weinrauch MD, can be reached at lweinrauch@hms.harvard.edu.
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