research summary

Treatment Modification Is Common Among Patients With T2D for Second-Line Medications

Almost two-thirds of patients with type 2 diabetes modified their medication regimen within 1 year of initiating a noninsulin second-line antidiabetic medication (ADM), with discontinuation being the most common change to their regimen.

To identify changes and the characteristics of these changes in patients’ ADM use, researchers utilized private health plan claims for adults with type 2 diabetes over a 12-month follow-up period.

All participants initiated one of five index AMD classes: sulfonylureas, dipeptidyl peptidase 4 inhibitors (DPP4is), sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or thiazolidinediones. The primary outcomes included discontinuation, switching, and intensification of the patients’ medication regimens.

A total of 63.6% of the 82,624 included participants had modifications to their treatment within the study period. Discontinuation was the most common modification, occurring in 38.6% of patients. More than half of patients who discontinued their medication were prescribed GLP-1 RAs (50.3%). Intensification was the next common modification followed by switching, at 19.8% and 5.2%, respectively.

When compared with patients prescribed sulfonylureas in adjusted analysis, the discontinuation risk was increased 7% (hazard ratio [HR] = 1.28; 95% CI, 1.04 to 1.10) among patients prescribed DPP4is. Further, the discontinuation risk was 28% higher (HR = 1.28; 95% CI, 1.23 to 1.33) among patients prescribed GLP-1 RAs. All other index ADM classes had higher risks of switching and lower risks of intensification when compared with sulfonylureas.

Higher risks of all modifications were observed in patients of younger age groups and women. Additionally, index prescriptions by an endocrinologist were associated with a lower discontinuation risk and a higher intensification risk when compared with index prescriptions by a family medicine or internal medicine physician.

However, the researchers note that several limitations were present in the study. Patients classified as having no treatment modifications included those who changed medications within the same treatment class, as well as those who gradually increased their index dose over time. Basal insulin as a second-line ADM was excluded from the study, due to the inability to calculate treatment modification for this medication type.

“Most included patients modified their type 2 diabetes medication regimen within 1 year of initiating a noninsulin second-line AMD, most frequently via discontinuation of their index medication,” the researchers concluded. “Future research is needed to improve our understanding of barriers to ADM adherence among patients who discontinue second-line therapy and to test new prescribing approaches and patient supports to maximize medication adherence and reduce health system waste among patients who initiate second-line ADM therapy.”



Liss DT, Cherupally M, O’Brien MJ, et al. Treatment modification after initiating second-line medication for type 2 diabetes. Am J Manag Care. 2023;29(12):661-668. doi:10.37765/ajmc.2023.89466