The Association of Patients' demographics with glucose-lowering drugs prescription among patients with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies

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Abstract

Background: Multiple factors influence the prescribing decision of glucose lowering drugs (GLD) for patients with type 2 diabetes (T2D) in clinical practice. This includes patients' demographics (ex. age), which have an effect on GLD effectiveness and tolerability. Studying these factors might indirectly reflect prescribers' adherence to guidelines recommendation and specific drugs' features.
Objectives: This systematic review and meta-analysis (MA) aimed to quantify the impact of demographic factors reported to be associated with GLD prescription.
Methods: A systematic search was conducted on Medline, Embase, Scopus, and Web of Science. Quantitative observational studies evaluating demographic factors' association with GLD prescription for patients with T2D in the outpatient setting and published in English between Jan/2009-April/2021 were included. A total of 20% of studies were validated at each study screening step. Extracted items were: study details (author, year, design), patients’ characteristic (age, gender), GLD (metformin, sulfonylurea (SU), glucagon like peptide receptor agonist (GLP1-RA), sodium glucose transporter2 inhibitor (SGLT2-I), dipeptidyl peptidase4 inhibitor, thiazolidinedione (TZD), insulin), stage of treatment (initiation, intensification), statistical test used (adjusted, crude). Quality assessment was performed using the Newcastle Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. Three-level random effect model was used for calculating pooled estimates where applicable to estimate odds ratios and 95% confidence intervals of GLDs for different patient' demographics. Results: From 2331 studies, 38 were eligible. Age, gender, ethnicity, smoking status, and educational level were identified as demographic factors; MA was applied for age (n=31 studies) and gender (35 studies) based on the number of studies included per factor. Overall, both gender and age showed non-significant impact on the prescription of different GLDs (1.00[0.86-1.16], 0.93[0.66 -1.32], respectively). Yet, the impact varied according to the type of GLDs. Female patients were more likely to be prescribed GLP1-RA (1.38[1.19-1.60]), but less likely to get TZD prescription (0.91[0.84-0.98]). While age had significant associations with metformin, SU, GLP1-RA, and SGLT2-I (0.70[0.61-0.82], 1.51[1.30-1.76], 0.52[0.40 - 0.69], 0.57[0.42 - 0.79], respectively).
Conclusions: Age and gender are important demographics associated with GLD prescribing, yet they have variable impact on different GLD. The observed associations reflect consistency of GLD selection with specific drugs' features. More studies are needed to assess the impact of other patients’ demographics.
Original languageEnglish
Publication statusAccepted/In press - 11 May 2022
EventThe 38th International Conference on Pharmacoepidemiology and Risk Management : Advancing Pharmacoepidemiology and Real-World Evidence for the Global Community - Bella Centre , Copenhagen, Denmark
Duration: 24 Aug 202228 Aug 2022
https://www.eventscribe.net/2022/ICPE/

Conference

ConferenceThe 38th International Conference on Pharmacoepidemiology and Risk Management
Abbreviated titleICPE 2022
Country/TerritoryDenmark
CityCopenhagen
Period24/08/2228/08/22
Internet address

Keywords

  • Association of Patients
  • demographics
  • glucose-lowering drugs prescription
  • type 2 diabetes
  • systematic review
  • meta-analysis

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