Determinants of treatment modification before and after implementation of the updated 2015 NICE guideline on type 2 diabetes: A retrospective cohort study

Judith van Dalem, Martijn C. G. J. Brouwers, Andrea M. Burden, Coen D. A. Stehouwer, Olaf H. Klungel, Frank de Vries*, Johanna H. M. Driessen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims: To identify patient-specific factors associated with early metformin treatment modification among type 2 diabetes patients before and after implementation of the updated 2015 NICE (National Institute for Health and Care Excellence) guideline. Methods: We conducted a population-based cohort study using data from the Clinical Practice Research Datalink GOLD database (2009-2016). Patients > 18 years, newly treated with metformin only, during the period of valid data collection were included. The first prescription defined start of follow-up. Determinants of treatment modification in two cohorts (before and after implementation of the updated guideline) were studied by time-dependent Cox proportional hazards regression. Results: After implementation of the updated guideline, patients were less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% vs 2.2%) and more likely to receive dipeptidyl peptidase-4 inhibitors (15.8% vs 27.1%) or sodium-glucose cotransporter-2 inhibitors (0.8% vs 9.9%). Some determinants influenced general practitioners' prescribing differently after implementation of the updated guideline compared to before, including a high body mass index and heart failure. Conclusions: Our results indicate that a first step towards tailored prescribing has been made. However, not all determinants that are important to consider when prescribing

Original languageEnglish
Article number108828
Number of pages14
JournalDiabetes Research and Clinical Practice
Publication statusPublished - Jun 2021


  • Diabetes Mellitus Type 2
  • Hypoglycaemic agents
  • Drug utilisation
  • Sulphonylureas
  • CARE

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