Trends in anti-hyperglycaemic drug usage among Danish type 2 diabetes patients on second-line treatment and beyond: A nationwide cohort study

  1. Henrik Vitus Bering Laursen
  2. Flemming Witt Udsen
  3. Morten Hasselstrøm Jensen
  4. Peter Vestergaard
  5. Søren Paaske Johnsen
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Abstract

2

OBJECTIVE

The paradigm shift introduced by the glucagon-like peptide-1 (GLP1) receptor agonist and sodium-glucose co-transporter-2 (SGLT2) inhibitor classes of drugs has led to changes in treatment practices in Denmark. The aim of this study was to investigate what these changes were before and after the implementation of the 2018 guidelines in Denmark.

RESEARCH DESIGN AND METHODS

Registry data on prescriptions was linked with other registries to create a descriptive overview of treatment patterns was carried out for a nationwide cohort of all individuals receiving at least two non-insulin anti-diabetic drugs (NIADs) between 2012 and 2021.

RESULTS

A cohort of 66,188 individuals was identified. The treatment patterns reflected significantly higher use of SGLT2 and GLP1 over time, eclipsing all other drugs, except for insulin, at later treatment stages. First-line use of SGLT2 and GLP1 also became higher over time, as did their likelihood of prescription at later stages. Their combined use rivaled insulin usage at similar stages by 2021. First-line use for women were high in the GLP1 group.

CONCLUSIONS

Our study finds that GLP1 and SGLT2 are used extensively for individuals who have tried multiple NIADs and may delay the use of insulin. Furthermore, there is an increased trend in their first-line use.

Key messages

  • What is already known on this subject

  • ○

    Increase in use of SGLT2 and GLP1 is documented, but changes in treatment patterns specifically for a cohort of people with type 2 diabetes before and after the publication of the 2018 treatment guidelines has not.

  • What did we find?

  • ○

    A marked increase in SGLT2 and GLP1 utilization, an indication that insulin initiation is postponed following this, and a preference for GLP1 in younger people in the cohort.

  • What are the implications of our findings?

  • ○

    Introduction of SGLT2 and GLP1 has led to major changes in the treatment practice of type 2 diabetes. Systematic population-based monitoring is highly warranted to ensure that treatment practice remain compliant with clinical guidelines recommendations.

    • Article activity feed

    1. Version published to 10.1101/2025.06.20.25328883v2 on medRxiv
    2. Version published to 10.1101/2025.06.20.25328883v1 on medRxiv