The type 2 diabetes market is expanding rapidly, fueled by increasing prevalence and a wave of recent product launches. Sanofi’s Suliqua (lixisenatide/insulin glargine), Novo Nordisk’s Fiasp, and AstraZeneca’s Glyxambi (linagliptin/empagliflozin) are examples of recent European product approvals. DRG believes the positive results from the EMPA-REGCVOT for Boehringer Ingelheim’s/Eli Lilly’s Jardiance will benefit uptake of the entire SGLT-2 inhibitor class. Current Treatment explores how the prescribing behaviors of European endocrinologists have changed in response to the rise of the SGLT-2 inhibitors and how other novel drugs compare.

Table of contents

  • Type 2 Diabetes - Current Treatment - Detailed, Expanded Analysis: Physician Insights (EU5)
    • Introduction to Current Treatment for Type 2 Diabetes
      • SGLT-2 Inhibitors and GLP-1 Receptor Agonists Benefit from CV and Weight Loss Effects
      • Summary Figures
      • Introduction to Current Treatment and Medical Practice for Type 2 Diabetes
      • Drugs Included in This Study of Current Treatment of Type 2 Diabetes
    • Physician Prescribing Practices
      • Patient Share of GLP-1 Receptor Agonists and SGLT-2 Inhibitors Set to Grow
      • Patient Characteristics
        • Mean Lab Values, BMI, and Prevalence of Complications Reflect Type 2 Diabetes Disease Severity
        • Mean HbA1c at Time of Referral to Endocrinologists
        • Mean FPG at Time of Referral to Endocrinologists
        • Frequency of Comorbidities in Type 2 Diabetes Patients (EU5 Total)
        • Stratification of Patient HbA1c Levels (EU5 Total)
        • Stratification of Type 2 Diabetes Patients by BMI (EU5)
        • Stratification of Type 2 Diabetes Patients by BMI (EU5 Total)
        • Frequency of Diabetic Complications in Type 2 Diabetes Patients (EU5 Total)
        • Mean Insulin Units Prescribed Per Type 2 Diabetes Patient Per Day
      • Treatment Practices
        • SGLT-2 Inhibitors and GLP-1 Receptor Agonists Prominent in Treatment Algorithm
        • Mean Time of 1.5 Years from Diagnosis to Treatment Initiation
        • Mean Times for Progression Though Lines of Therapy
        • Mean Times for Progression Between Lines of Therapy by Physician Type (EU5 Total)
        • Treatment Rates High for Type 2 Diabetes
        • Drug-Treatment Rates for Prediabetes by Physician Type (EU5 Total)
        • Drug-Treatment Rates for Type 2 Diabetes by Physician Type (EU5 Total)
        • Anticipated Changes to Type 2 Diabetes Treatment Rates in Five Years (EU5 Total)
        • Changes to Type 2 Diabetes Treatment Rates in Six Months (EU5 Total)
        • Percentage by Which Treatment Rates Will Increase in Six Months
        • Percentage by Which Treatment Rates Will Increase in Five Years
        • Empagliflozin and Dulaglutide Are Established Therapies
        • Patient Share of the DPP-IV Inhibitor Class by Product
        • Patient Share of the GLP-1 Receptor Agonist Class by Product (EU5 Total)
        • Patient Share of Insulin by Insulin Subtype (EU5 Total)
        • Patient Share of Rapid-Acting Insulins by Product (EU5 Total)
        • Patient Share of Long-Acting Insulins by Product (EU5 Total)
        • Patient Share of Premixed Insulins by Product (EU5 Total)
        • Patient Share of Alpha-Glucosidase Inhibitors by Product (EU5 total)
        • Patient Share of Meglitinides by Product (EU5 Total)
        • Patient Share of SGLT-2 Inhibitors by Product (EU5 Total)
        • Treatment Duration by Drug Class (EU5 Total)
        • Metformin Dominates First-Line Treatment, but SGLT-2 Inhibitors Garner Use at the Second Line
        • A Large Percentage of Type 2 Diabetes Patients Progress to Fourth-Line Treatment
        • Treatment Rates by Line of Therapy (EU5 Total)
        • Progression Between Lines of Type 2 Diabetes Therapy Takes Years
        • Mean Progression Time Between Lines of Therapy (EU5 Total)
        • SGLT-2 Inhibitors Are a Popular Second-Line Drug Class, While Injectable Classes Are Reserved for the Third Line or Later
        • First-Line Patient Share by Drug Class (EU5 Total)
        • Second-Line Patient Share by Drug Class (EU5 Total)
        • Third-Line Patient Share by Drug Class (EU5 Total)
        • Despite the Costs, Branded Therapies Are Frequently Used in Combination
        • Mean Number of Drugs Per Patient by Physician Type (EU)
        • Drug Combination Most Likely to Prescribe
        • Drug Combination Second Most Likely to Prescribe
        • Drug Combination Third Most Likely to Prescribe
      • Persistency and Compliance
        • The Most Popular Antidiabetic Classes Have Compliance Rates of 60-70%
        • Persistency and Compliance by Drug Class (EU5 Total)
      • Sequencing of Treatment
        • SGLT-2 Inhibitors Are Incorporated into Early Lines of the Treatment Algorithm
        • Treatments Preceding GLP-1 Receptor Agonist Use
        • Treatments Preceding Insulin Use
        • Treatments Preceding SGLT-2 Inhibitor Use
      • Recent/Anticipated Changes in Brand Use/Treatment Approach
        • SGLT-2 Inhibitors and GLP-1 Receptor Agonists Anticipated to Have Greatest Increase in Use
        • Anticipated Changes to Drug Class Prescribing (EU5 Total)
    • Physician Insight on Medical Practice
      • CV End Points and Weight Loss Are Key Differentiators in Type 2 Diabetes
      • Drivers of Treatment Selection
        • Balance of Efficacy and Hypoglycemia Drives Treatment
        • Treatement Is Adapted During Progression of Type 2 Diabetes
        • Stratification of Type 2 Diabetes Patients by BMI (EU5 Total)
        • Mean HbA1c at Time of Referral to Endocrinologists
        • Frequency of Diabetic Complications in Type 2 Diabetes Patients (EU5 Total)
        • Changes to Type 2 Diabetes Treatment Rates in Six Months (EU5 Total)
        • Factors That Influence Therapy Selection (EU5 Total)
        • HbA1c-Lowering Is Most Influential Attribute
        • Top Three Factors That Influence Therapy Selection (EU5)
        • Overall Satisfaction with Drug Classes (EU5 Total)
        • Mean Overall Satisfaction with Drug Classes (EU5 Total)
        • Rating of Product Effectiveness in Lowering HbA1c (EU5 Total)
        • Mean Rating of Effectiveness in Lowering HbA1c (EU5 Total)
        • Side Effects and Tolerability Barriers to Treatment Selection
        • Top Factors That Prevent Selection of Antidiabetic Therapy (EU5 Total)
        • Rating of Drug Performance on Risk of Hypoglycemia (EU5 Total)
        • Mean Rating of Drug Performance on Risk of Hypoglycemia (EU5 Total)
        • Failure to Control HbA1c Is the Number One Reason for Switching
        • Factors That Drive Switching of Medication (EU5, All Physicians)
        • Factors That Drive Switching of Medication (EU5 Total, All Physicians)
        • Factors That Drive Endocrinologists' Switching of Medication (EU5 Total)
        • Factors That Drive PCPs' Switching of Medication (EU5)
        • Factors That Drive PCPs' Switching of Medication (EU5 Total)
    • Methodology
      • Primary Market Research Methodology
      • In Which Country Is Your Practice Located?
      • Physician Speciality By Country
      • Mean Number of Type 2 Diabetes Patients Under Management
      • Drug Classes Currently Prescribed (EU5)
      • Drug Classes Currently Prescribed (EU5 Total)
      • Mean Number of Years in Practice (Stratified)
      • Mean Number of Years in Practice
    • Appendix
      • Primary Market Research
        • Top Factors That Prevent Selection of Antidiabetic Therapy (EU5)
        • Rating of Drug Performance on Risk of Hypoglycemia (EU5)
        • Mean Rating of Drug Performance on Risk of Hypoglycemia (EU5)
        • Overall Satisfaction with Drug Classes (EU5)
        • Mean Overall Satisfaction with Drug Classes (EU5)
        • Rating of Product Effectiveness in Lowering HbA1c (EU5)
        • Mean Rating of Effectiveness in Lowering HbA1c (EU5)
        • Anticipated Changes to Drug Class Prescribing (EU5)
        • Persistency and Compliance by Drug Class (EU5)
        • First-Line Patient Share by Drug Class (EU5)
        • Second-Line Patient Share by Drug Class (EU5)
        • Third-Line Patient Share by Drug Class (EU5)
        • Mean Progression Time Between Lines of Therapy (EU5)
        • Treatment Rates by Line of Therapy (EU5)
        • Treatment Duration by Drug Class (EU5)
        • Patient Share of the GLP-1 Receptor Agonist Class by Product (EU5)
        • Patient Share of Insulin by Insulin Subtype (EU5)
        • Patient Share of Rapid-Acting Insulins by Product (EU5)
        • Patient Share of Long-Acting Insulins by Product (EU5)
        • Patient Share of Premixed Insulins by Product (EU5)
        • Patient Share of Alpha-Glucosidase Inhibitors by Product (EU5)
        • Patient Share of Meglitinides by Product (EU5)
        • Patient Share of SGLT-2 Inhibitors by Product (EU5)
        • Drug-Treatment Rates for Prediabetes by Physician Type (EU5)
        • Drug-Treatment Rates for Type 2 Diabetes by Physician Type (EU5)
        • Anticipated Changes to Type 2 Diabetes Treatment Rates in Five Years (EU5)
        • Anticipated Changes to Type 2 Diabetes Treatment Rates in Six Months (EU5)
        • Percentage by Which Treatment Rates Will Decrease in Six Months
        • Frequency of Comorbidities in Type 2 Diabetes Patients (EU5)
        • Stratification of Patient HbA1c Levels (EU5)
        • Frequency of Diabetic Complications in Type 2 Diabetes Patients (EU5)
      • Abbreviations

Author(s): Gideon Heap

As a Principal Analyst on the Cardiovascular, Metabolic and Renal Disorders team, Gideon has a wealth of experience and expertise in pharmaceutical market analysis. In addition to creating Disease Insights covering metabolic disorders, Gideon has experience in company strategy and portfolio analysis for DRG’s Company & Drug platform.

Gideon has a Masters in Biochemistry with Biological Chemistry from the University of Nottingham, and his industry experience dates back to 2009.


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