Evaluation of clinically non-preferred medications for the initial treatment of Type 2 diabetes within Providence Medical Group Oregon Region
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Publication Date
2025
Abstract
Abstract: Type 2 Diabetes Mellitus (T2DM) affects 1 in 10 American adults and increases a patient’s risk for developing complications, such as atherosclerotic cardiovascular disease, chronic kidney disease, and heart failure. Choosing the most optimal medications and controlling blood glucose can help prevent and/or reduce the risk of T2DM complications. Metformin has been the preferred initial agent for managing diabetes because it provides effective glycemic control, reduces the risk of microvascular complications, and lowers rates of cardiovascular-related mortality. In 2023, the American Diabetes Association recommended considering newer agents with cardiorenal and/or weight loss benefits, such as glucagon like peptide-1 agonists (GLP-1) or specific sodium glucose like transport-2 inhibitors (SGLT-2i), as preferred initial options independent of metformin use. While GLP-1, SGLT-2i and metformin are classified as clinically preferred initial treatments, it may be appropriate to use other medications as alternatives depending on patient specific factors and overall glycemic control. However, with the lack of cardiorenal risk reduction benefits and additional concerns for side effects, these agents are typically considered less preferred. There are various situations where using a clinically non-preferred medication might be suitable, although there is not much information available about the specific circumstances and reasons for this in practice. The purpose of this study is to describe prescribing patterns and rationale for the use of clinically non-preferred T2DM medications as initial therapy for T2DM within Oregon Providence Medical Group (PMG) primary care clinics. This is a multi-site, retrospective, descriptive analysis of patients who were prescribed a clinically non-preferred treatment as ini-tial therapy for T2DM between January 1st, 2023, to December 31st, 2024, either before or after the initiation of metformin. Patients to be analyzed were >18 years of age and from PMG primary care clinics in the Oregon region. Patients were excluded if pregnant, imprisoned, or being cared for at a residency teaching clinic. Epic electronic medical records were queried by a data analyst to generate a report of patients with an initial clinically non-preferred treatment for T2DM. Approximately 200 patients will be randomly selected for manual chart review to help determine the rationale for initiating non-preferred treatments along with clinical appropriateness based on patient specific factors. Descriptive statistics will be used to analyze the baseline characteristics of the study population, prescribing patterns, and rationale. Results and Conclusions will be shared when the project is completed. (IRB approved)
Specialty/Research Institute
Graduate Medical Education
