Adherence to NICE guidance on @entity5445 receptor agonists among @entity1 with XXXX : an evaluation using the Clinical Practice Research Datalink.

@entity1 @entity4051 @entity6 @entity56 @entity164 @entity8142 @entity5445
AIMS: To assess adherence to the UK's National Institute for Health and Care Excellence (NICE) guidelines for initiating and continuing @entity5445 ( @entity8142 agonists in @entity1 with @entity164 2 @entity6 (T2DM). RESEARCH DESIGN AND METHODS: A retrospective cohort study of 7133 primary care @entity1 >= 40 years with a first prescription for a @entity8142 agonist following publication of NICE guideline/guidance. @entity1 characteristics and levels of clinical monitoring were assessed using descriptive analyses. MAIN OUTCOME MEASURES: Main outcomes were the proportion of @entity1 initiating @entity8142 agonists as part of NICE-recommended dual- or triple-therapy regimens; the proportions meeting NICE triple therapy initiation criteria (glycosylated hemoglobin [HbA1c] >= 7.5% and body mass index [BMI] >= 35   kg/m(2)) and the proportions continuing @entity8142 agonist at 6 months according to NICE recommendations. RESULTS: Mean age at initiating @entity8142 agonists was 58.2 years (SD 9.4), BMI 38.4   kg/m(2) (SD 6.8) and HbA1c 9.2% (SD 3.2%). Overall, only 25% of @entity1 initiated @entity8142 agonists as part of a NICE-recommended regimen. Of @entity1 initiated on a recommended triple-therapy regimen, 50% (646/1284) fulfilled both NICE HbA1c and BMI initiation criteria. Approximately 18% (32/174) of @entity1 continuing NICE-recommended dual therapy at 6 months achieved a 1% reduction in @entity4051 c and 6.4% (33/515) continuing with NICE-recommended triple therapy achieved NICE's target reductions for both HbA1c and body weight. About 8% of @entity1 continuing exenatide as triple therapy (N   =   243) achieved both targets. CONCLUSIONS: Adherence to NICE guidance for initiating and continuing @entity8142 agonists is low. However, lack of data on ethnicity (for assessing NICE's BMI criteria) and on contraindications and/or @entity56 to other @entity6 medication in the treatment pathway have limited our ability to fully assess adherence to @entity5445 prescribing. Further research is warranted to better understand general practitioners' prescribing decisions given the cost of prescribing @entity8142 agonists.
