The use of modern hypoglycemic drugs in the treatment of type 2 diabetes mellitus (according to the Moscow segment of the Federal Diabetes Registry)

• Mikhail B. Antsiferov
• Nikolay A. Demidov
• Olga M. Koteshkova

Abstract

Over the past 15 years, the arsenal of non-insulin drugs for the treatment of type 2 diabetes mellitus (T2DM) has been significantly expanded. Glucagon-like peptide‑1 receptor agonists (GLP‑1 RAs), dipeptidyl peptidase type 4 inhibitors (DPP‑4i), and sodium glucose cotransporter type 2 inhibitors (SGLT‑2i) are increasingly being used. At the same time GLP‑1 RAs and SGLT‑2i, in addition to hypoglycemic effects, also demonstrate cardio-renoprotective properties. The widespread use of these drugs classes leads not only to a decrease in the risk of cardiovascular diseases, but also to an increase in the life expectancy in patients with T2DM. Of interest is the modern use of these drugs classes in real clinical practice in Moscow.

Aim. To study the dynamics of frequency of use of modern hypoglycemic drugs classes, especially with cardio- and reno-protective properties in cohorts of patients with a very high cardiovascular risk in patients with T2DM in Moscow.

Material and methods. Using sampling from the Moscow segment of the Federal Diabetes Registry (FRDM), we analyzed the dynamics of the frequency of use of modern hypoglycemic drugs classes in patients with T2DM, in particular, drugs with cardio- and nephroprotective properties in cohorts of patients with very high cardiovascular risk.

Results. As of January 1, 2023, the number of patients with T2DM was 329.8 thousand people, according to the data of the Moscow segment of the FRDM.

136 869 people (41.4% of all T2DM patients) received new classes of drugs [SGLT‑2i (70 773 people – 21.5%), DPP‑4i (57 153 people – 17.3%), GLP‑1 RAs (8943 people – 2.7%)].

The proportion of patients with chronic heart failure (excluding ejection fraction indicators) receiving iSGLT‑2 during the observation period from 01.01.2021 to 01.01.2023 increased by 3 times (from 16.7 to 52.1%), the total number increased by 12 times (from 1209 to 14 527 people).

The proportion of post-MI (post-myocardial infarction) patients receiving SGLT‑2i and/or GLP‑1 RAs increased by 4 times (from 10.4 to 42.3%), the total number of these patients increased from 1844 to 8257 people.

The proportion of patients who had a stroke and received SGLT‑2i and/or GLP‑1 RAs also increased by 4 times (from 6.2 to 25.7%), the total number – from 1095 to 4448 people.

Conclusion. An analysis of the use of drugs with cardio and nephroprotective properties in real clinical practice demonstrates an increase in the number of patients with T2DM receiving SGLT‑2i and GLP‑1 RAs classes, according to the FRDM.

Keywords:cardioprotection; nephroprotection; DPP 4i; GLP 1 RAs; SGLT 2i; Federal Diabetes Registry

References

1. Kieffer T.J., Habener J.F. The glucagon-like peptides. Endocr Rev. 1999; 20 (6): 876–913. DOI: https://doi.org/10.1210/edrv.20.6.0385

2. D’Alessio D.A., Vahl T.P. Utilizing the GLP-1 signaling system to treat diabetes: sorting through the pharmacologic approaches. Curr Diab Rep. 2005; 5 (5): 346–52. DOI: https://doi.org/10.1007/s11892-005-0092-2

3. Gerstein H.C., Colhoun H.M., Dagenais G.R., et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo controlled trial. Lancet. 2019; 394 (10 193): 121–50. DOI: https://doi.org/10.1016/S-0140-6736(19)31149-3

4. Cordiner R., Fisher M., Drummond R. SUSTAIN-6: cardiovascular safety of a once-weekly GLP-1 receptor agonist. Pract Diabetes. 2016; 33 (8): 266–74. DOI: https://doi.org/10.1002/pdi.2051

5. Marso S.P., Bain S.C., Consoli A., et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016; 375 (19): 1834–77. DOI: https://doi.org/10.1056/NEJMoa1607141

6. Hernandez A.F., Green J.B., Janmohamed S., D’Agostin R.B., Granger C.B., Jones N.P., et al.; Harmony Outcomes Committees and Investigators. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet. 2018; 392 (10 157): 1519–29. DOI: https://doi.org/10.1016/S-0140-6736(18)32261-X

7. Scirica B.M., Bhatt D.L., Braunwald E., et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013; 369 (14): 1317–42.

8. Verma S. Potential mechanisms of sodium-glucose co-transporter 2 inhibitor-related cardiovascular benefits. Am J Cardiol. 2019; 124 (suppl 1): 36–44. DOI: https://doi.org/10.1016/j.amjcard.2019.10.028

9. Verma S., Juni P., Mazer C.D. Pump, pipes, and filter: do SGLT2 inhibitors cover it all? Lancet. 2019; 393: 3–5. DOI: https://doi.org/10.1016/S-0140-6736(18)32824-1

10. Santos-Ferreira D., Goncalves-Teixeira P., Fontes-Carvalho R. SGLT-2 inhibitors in heart failure and type-2 diabetes: hitting two birds with one stone? Cardiology. 2020; 145: 311–20. DOI: https://doi.org/10.1159/000504694

11. Neal B., Perkovic V., Mahaffey K.W., de Zeeuw D., Fulcher G., Erondu N., et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377: 644–57. DOI: https://doi.org/10.1056/NEJMoa1611925

12. Wiviott S.D., Raz I., Bonaca M.P., Mosenzon O., Kato E.T., Cahn A., et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380: 347–57. DOI: https://doi.org/10.1056/NEJMoa1812389

13. Zinman B., Wanner C., Lachin J.M., Fitchett D., Bluhmki E., Hantel S., et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373: 2117–28. DOI: https://doi.org/10.1056/NEJMoa1504720

14. ElSayed N.A., Aleppo G., Aroda V.R., et al.; American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes-2023. Diabetes Care. 2023; 46 (suppl 1): S 140–57.

15. Zelniker T.A., Wiviott S.D., Raz I., Im K., Goodrich E.L., Furtado R.H.M., et al. Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation. 2019; 139: 2022–31. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.038868

16. Figtree G.A., Radholm K., Barrett T.D., Perkovic V., Mahaffey K.W., de Zeeuw D., et al. Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes mellitus. Circulation. 2019; 139: 2591–3. DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.040057

17. Antsiferov M.B., Demidov N.A., Balberova M.A., Lobanova O.V., Mudrikova I.G., Gusenbekova D.G. Influence of type 2 sodium-glucose co-transporter inhibitors (dapagliflozin) on the indicators of total mortality in patients with type 2 diabetes (CARDIA-MOS study, Moscow). Sakharniy diabet [Diabetes Mellitus]. 2022; 25 (5): 439–48. DOI: https://doi.org/10.14341/DM12929 (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)