SGLT2 inhibitors — a group of oral drugs for type 2 diabetes that includes Farxiga (generic name dapagliflozin), Invokana (canagliflozin), Steglatro (ertugliflozin) and Jardiance (empagliflozin) — are not likely to be cost-effective as the main treatment taken to lower blood glucose, compared with less expensive drugs that lower glucose just as effectively or better, according to a new study published in the Journal of Diabetes and its Complications.
Increased use of SGLT2 inhibitors
The researchers looked at a group of 4,625 people with both type 2 diabetes and hypertension (high blood pressure) to assess the impact of the introduction of SGLT2 inhibitors to the U.S. market on both prescribing patterns and A1C levels (a measure of long-term blood glucose control). They found that the introduction of these drugs did change the way doctors prescribed medications to treat type 2 diabetes, with the proportion of people taking SGLT2 inhibitors growing from 0% (between January 2010 and December 2012) to 14% (between January 2014 and December 2016). During the same period, use of insulin also grew from 56.1% to 60.5%, while the use of metformin fell from 69.5% to 66.3%, and the use of sulfonylureas fell from 44.7% to 39.4%.
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Clinical guidelines from the American Diabetes Association and other medical groups recommend metformin as the first-line glucose-lowering drug treatment for most people with type 2, so the slight drop in its popularity — along with the rise of SGLT2 inhibitors — may indicate that these guidelines aren’t being followed in many cases.
Of course, doctors are free to prescribe any drug to help people with type 2 lower their blood glucose levels, whatever the guidelines say. But in this study, the researchers found that SGLT2 inhibitors carry a bigger price tag without any meaningful glucose-lowering benefits. Despite the substantial increase in the use of these drugs, the average A1C level in the study group fell only from 7.9% to 7.8%, while their body-mass index (BMI, a measure of body weight that takes height into account) fell from 32.5 to 32.1. Meanwhile, systolic blood pressure (the “top number”) actually rose from 130 to 132 mmHg.
The researchers noted that SGLT2 inhibitors are undoubtedly appropriate for some people with type 2 — in particular, those who can’t adequately control their glucose levels with other oral drugs, and those with heart failure, for which SGLT2 inhibitors are approved as a treatment. But they concluded that aside from these narrow situations, “SGLT-2 inhibitor use may not be cost effective” due to the much higher prices of these drugs.
“Enthusiasm for use of SGLT-2 inhibition,” the researchers continued, “should be based upon long-term cardiorenal protection” — heart and kidney function benefits — “rather than short-term glycemia control given limited impact upon HbA1c levels.”
If you have questions or concerns about the cost of taking SGLT2 inhibitors or any other drugs, talk to your doctor about whether more affordable alternatives may be an option for you.
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