Review of non-insulin antidiabetic pharmacotherapy in patients with heart failure and diabetes mellitus in the Czech Republic in 2018

Abstract

Aim: Retrospective observational analysis of non-insulin antidiabetic pharmacotherapy reported to the National Register of Paid Health Services (NRHHS) in the Czech Republic (CR) in patients with heart failure (HF) and concomitant diabetes mellitus (DM) in 2018. Methods: Individuals with a comorbid diagnosis of heart failure (I50.x) and diabetes mellitus (E10–E14) based on ICD-10 classification and reported ATC drug code. Results: In 2018, 117,265 people were diagnosed with both HF and DM. At least one antidiabetic drug (insulin or non-insulin) was reported in 88 749 patients (75.7% of the prevalence of HF and DM). Metformin was the dominant non-insulin drug therapy (45.6% overall). In fixed combination with metformin, dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) predominated in 5.4%, slightly less sodium-glucose transporter 2 inhibitors (SGLT-2 inhibitors) in 1.5%. Sulphonylurea derivatives, namely gliclazide (10.3%) and glimepiride (9.0%), had the second highest representation in the analysis, followed by DPP-4 inhibitors, mainly linagliptin (6.8%). Among the SGLT-2 inhibitors, empagliflozin (1.8%) and dapagliflozin (0.8%) predominated. Subcutaneously administered glucagon-like polypeptide 1 receptor agonists (GLP-1 agonists) alone were used by 0.7% of the prevalent HF and DM subjects, in fixed combination with insulin (degludec-liraglutide) by 1.1% and glargine-lixisenatide by 0.1%. Conclusion: The most commonly used oral antidiabetic drug in people with HF and DM in 2018 was metformin, similarly as in other foreign registries. Sulfonylurea derivatives continue to hold an important position, despite the absence of benefits on mortality, or morbidity in heart failure patients. With the advent of large randomized trials and registration of new molecules, the importance of SGLT-2 inhibitors and GLP-1 agonists is increasing in persons at high cardiovascular risk.