Experts have called for “new prescribing approaches” after research highlighted just how many people with type 2 diabetes stop taking their second-line medication.

Second-line medication is commonly prescribed to people with type 2 diabetes after metformin, a drug commonly used for blood glucose management.

However, sticking with this medication has been shown to be hit and miss, with the team behind the study saying that a new approach is needed to save patients’ and clinicians’ time and money spent by healthcare services.

A study by Northwestern Medicine in Chicago looked at data from almost 82,000 people from 2014 to 2017.

Researchers found that after a year following their initial prescription, almost two-thirds of individuals had either stopped their medication, changed to a different class of medication or intensified their treatment.

The team evaluated the use of five different diabetes medications, excluding insulin, finding that 38% of people stopped their medication in four out of the five classes of medication.

The highest stop rate was seen in those prescribed GLP-1 RAs, with half discontinuing their treatment.

Corresponding author David Liss, a research associate professor of general internal medicine, said: “Discontinuation is bad. It is common in all five types of medications, but we see significantly more in those prescribed the GLP-1 RAs.

“Presumably, the doctor is saying, ‘You need to start a new medication to control your type 2 diabetes,’ and then within a year, half of them just stop and don’t start another one, and that’s not a good thing.

“Our findings highlight the need for new prescribing approaches and to better understand the barriers patients face when taking these medications, to ultimately reduce wasting patients’ time, clinicians’ time and the health system’s money.”

The team behind the findings do not have any evidence of why people stop treatment.

However, the side effects to GLP-1 RAs, which can include nausea, vomiting and diarrhoea, could go some way to explaining the discontinuation rate for this type of treatment.

While stopping their medication wouldn’t immediately trigger high blood sugar or a medical emergency for many of the participants in the study, the researchers have urged caution, saying: “Discontinuation still puts these patients at greater risk for downstream hospitalisations related to diabetes.”

They also believe that in many cases, people stopped their treatment without talking to their doctor first.

Liss concluded: “Our results may represent a ‘wake-up call’ for clinicians that many of their patients were not taking the medicines that were prescribed.

“While we don’t know if providers were aware of the discontinuation events observed in this study, our results highlight the need for ongoing communication between patients and prescribers over time – around medication benefits, side effects and costs – not just at the time of prescribing.”

Read the full study in AJMC.

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