Ulster University

Academic Institute

Paula McClean

E063

Diabetes is a metabolic disease associated with elevated blood glucose with an estimated global prevalence of ~500 million, and 3.8 million diagnosed individuals in the UK. Type 2 diabetes (T2D) accounts for ~90% of diabetes cases and is caused by insulin resistance and deficiency. T2D costs the NHS £10billion per year, with majority of costs associated with secondary complications. Common secondary complications of T2D include cardiovascular disease, which is the leading cause of mortality in T2D, kidney disease and retinopathy (the leading cause of blindness). Cognitive decline and mood dysfunction are lesser well-known complications of T2D, that significantly impact disease management. Glucagon-like peptide-1 (GLP-1) agonists are a class of T2D drugs that have demonstrated numerous off-target benefits (i.e. benefits beyond improvement in blood glucose management), with respect to weight-loss, cardiovascular disease and all-cause mortality. There is also evidence to suggest that GLP-1 agonists can improve cognitive function and mood. The present study will identify all individuals prescribed type 2 diabetes medication, together with drugs used in the treatment of depression, anxiety and dementia. Analysis of T2D prescription data at a population level will permit identification of prescribing patterns of T2D drugs and allow us to compare co-prescription of drugs to treat depression, anxiety and dementia in those receiving different T2D drugs. To do this, we will request data from the Honest Broker Service (HBS) for all individuals prescribed T2D drugs in Northern Ireland and will also request data for drugs to treat depression, anxiety and dementia in the same individuals.

Type 2 diabetes accounts for 90% of all cases of diabetes and is continually growing in prevalence, costing the NHS £10billion per year, 10% of the annual budget. Majority of the cost of T2D is due to secondary complications associated with glycemic control (1). It has been found that with a 1% reduction in HbA1c there is a significant reduction in secondary complications so any response to glycemic control therapy should reduce the risk of secondary complications developing such as renal failure, retinopathy and cardiovascular disease (CVD) (2). Lesser known complications of diabetes include higher risk of mood disorders such as anxiety and depression and cognitive deficits and an increased risk of developing Alzheimer’s disease (3)(4). It has been found that 40% of those with diabetes experience poor psychological wellbeing, and poor mental health has been associated with suboptimal disease management, further increasing the risk of diabetic secondary complications (5). The proposed study will assess differences in prescribing patterns of antidepressants, anxiolytics and dementia drugs with different classes of T2D medications. If we identify a significant reduction in such co-prescription for a particular T2D drug class, this could have a significant impact, in future, on T2D drug choice.

19/01/2021

TRE