Atlas of best-practice medicine use for diabetes

Diabetes medication

Novel antidiabetic medicines are revolutionising cardiometabolic care, with proven benefits of glycaemic control as well as a range of improved cardiovascular outcomes. However, these medicines are greatly underutilised. This new research project will investigate variation in uptake of these medicines across New South Wales, and how disparities relate to geography and availability of services.

The project will be led by Dr Juliana de Oliveira Costa, a Research Fellow at the Medicines Intelligence (MedIntel) Research Program at the UNSW School of Population Health. Dr Juliana de Oliveira Costa was awarded a UNSW Cardiac, Vascular and Metabolic Medicine (CVMM) Theme Collaborative Grant for this research.

What is the key focus of this research?

Our research will create an ‘atlas’ of best-practice medicine use for treatment of type 2 diabetes across New South Wales. Specifically, we will quantify population-level use of two classes of glucose-lowering agents: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogues (GLP-1A). We will map out how these are being used relative to the prevalence of type 2 diabetes and estimated need. 

What motivated you to take up this topic?

We know both these classes of glucose-lowering agents vastly reduce cardiovascular death and improve heart and kidney outcomes, being considered one of most important developments in cardiometabolic medicine. While both medicine classes are subsidised by the Australian Government, we estimate less than a quarter of people living with type 2 diabetes are using these highly effective and potentially life-saving medicines. This is a huge evidence-practice gap.

We have recently established a population-based data platform to improve quality use of medicines in Australia, linking data hospital and community care for all residents of New South Wales. We are excited to use this data platform to investigate uptake of SGLT2i and GLP-1A, providing a unique and major opportunity to improve population health. 

What do you hope to achieve with this research?

Our goal is to increase the uptake of SGLT2i and GLP-1A among people with type 2 diabetes. Through our clinical collaborators, we know there are barriers to prescribing and use of these medicines. By identifying areas of high unmet need, we will provide the evidence needed to guide clinical outreach programs to improve prescribing and access to these medicines. Ultimately, this will help ensure people have equitable access to best-practice care, and improved outcomes, across all regions of New South Wales.

While this research is on uptake of SGLT2is and GLP-1a for treatment of diabetes, we will also create a framework for assessing the diffusion of therapies for other clinical populations, such as expansions in use of SGLT2is for conditions beyond type 2 diabetes (e.g. heart failure, chronic kidney disease). We will build capacity across UNSW research nodes in using large, population-based, linked datasets for understanding and improving uptake of best-practice medicines across Australia.

Who are you collaborating with to achieve these outcomes?

We are a multi-disciplinary team with expertise in the use of linked data, biostatistics, cardiometabolic research, quality use of medicines, clinical care, research translation and consumer engagement. This project is a collaboration between researchers of the MedIntel Research Program of the School of Population Health, the Garvan Institute of Medical Research, the Departments of Endocrinology and Clinical Pharmacology and St’s Vincent’s Clinical Campus, UNSW and consumer representatives of Diabetes Australia.

July 2023

Research Fellow Juliana de Oliveira Costa
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