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

AimsTo 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 Care Excellence) guideline.MethodsWe conducted a population-based cohort study using data from Clinical Practice Research Datalink GOLD database (2009–2016). Patients ≥ 18 years, newly treated only, during period valid collection were included. The first prescription defined start follow-up. Determinants in two cohorts (before guideline) studied by time-dependent Cox proportional hazards regression.ResultsAfter guideline, less likely to receive sulphonylureas (62.3% vs 41.3%) or thiazolidediones (4.7% 2.2%) more dipeptidyl peptidase-4 inhibitors (15.8% 27.1%) sodium-glucose cotransporter-2 (0.8% 9.9%). Some determinants influenced general practitioners’ prescribing differently guideline compared before, including high body mass index heart failure.ConclusionsOur results indicate that step towards tailored has been made. However, not all are important consider when second-line glucose-lowering agents influence on prescribing.