Innovative Study Describes Multinational Uptake Patterns of Cardioprotective Antidiabetic Drugs
Uptake of cardioprotective drugs has increased, but selective uptake in patients with diabetes and cardiovascular disease may be lacking, say researchers.
Researchers from the ‘Large-scale evidence generation and evaluation across a network of databases for type 2 diabetes mellitus’ (LEGEND-T2DM) collaborative have reported the patterns of use of novel cardioprotective antidiabetic drugs. The study, published October 6, in BMJ Medicine, could have implications for improving clinical care in patients with type 2 diabetes.
Novel antidiabetic drugs, such as GLP1 receptor agonists and SGLT2 inhibitors, have been shown to have cardiovascular benefits in patients with diabetes. These drugs lower blood glucose levels, and also reduce the risk of cardiovascular disease, such as heart failure and heart attack, and death. However, a thorough assessment of the patterns of use of these drugs across the world has been missing till now. The latest study in BMJ Medicine included 4.8 million patients across 17 data sources from 8 countries, and assessed the uptake of second-line drugs for diabetes treatment in patients already taking metformin.
"Cardioprotective antihyperglycemic drugs have shown immense clinical benefit over the last decade, lowering the risk of cardiovascular events in patients with diabetes. In this first study from the LEGEND-T2DM group, we found an increase in the uptake of these drugs as second-line agents, across US and International data sources”, said Rohan Khera, MD, MS, the study's first author, and Director of the Cardiovascular Data Science (CarDS) Lab at Yale.
“Aligning medication use with guideline recommendations is critical to improve outcomes for patients with type 2 diabetes. We believe our approach can serve as a benchmark for monitoring the uptake of antihyperglycemic drugs in response to changes in regional guidelines, insurance coverage, and contemporary evidence”
The researchers also report no difference in the patterns of uptake of these drugs between patients with or without heart disease. “While the uptake of these drugs increased across data sources, the uptake of these drugs was not selectively greater in patients with cardiovascular disease. This finding underscores the need for a consolidated strategy for improving the uptake of these drugs in patients who need them the most. Aligning medication use with guideline recommendations is critical to improve outcomes for patients with type 2 diabetes. We believe our approach can serve as a benchmark for monitoring the uptake of antihyperglycemic drugs in response to changes in regional guidelines, insurance coverage, and contemporary evidence", said Khera.
The LEGEND-T2DM collaborative is a part of the Observational Health Data Sciences and Informatics (OHDSI) network, a global consortium of physicians and scientists focusing on multi-site collaborations to generate scientific evidence that promotes better healthcare decision-making. Building on the techniques developed within the OHDSI network, this study followed an innovative federated design. This strategy allows for the inference of results without exchanging identifiable patient information between the researchers.
Marc Suchard, MD, PhD, the study’s senior author, and a Professor of Biostatistics, Biomathematics, and human Genetics at the UCLA Fielding School of Public Health, highlights the importance of these study designs, “OHDSI's open approach to scientific discovery is enabling federated clinical studies to be performed at a massive scale. LEGEND-T2DM establishes a federated framework that will guide future research in addressing the clinical questions in pharmacoepidemiology.”
“OHDSI’s open approach to scientific discovery is enabling federated clinical studies to be performed at a massive scale. LEGEND-T2DM establishes a federated framework that will guide future research in addressing the clinical questions in the field of pharmacoepidemiology.”
The LEGEND-T2DM studies follow the protocol previously established by the researchers and published in BMJ Open in 2022. “Global studies in the LEGEND-T2DM network can help fill in the critical gaps in our understanding of diabetes and cardiology that singular randomized trials cannot approach. We look forward to the continued collaboration and future studies from the LEGEND-T2DM collaborative”, said Suchard.
This study was funded in part by grants from the National Institutes of Health award (K23HL153775, R01 LM006910, and R01 HG006139) and an Intergovernmental Personnel Act agreement with the US Department of Veterans Affairs.