Diana Hedevang Christensen, Jørgen Rungby, Reimar Wernich Thomsen

The objective of this study was to examine nationwide population-based time trends in the utilization of all glucose-lowering drugs in Denmark from 1999 to 2014. Based on nationwide data from the Register of Medicinal Products Statistics, we retrieved sales statistics on glucose-lowering drugs and reported the total number of users and the prevalence of users per 1,000 inhabitants in 1-year intervals for all glucose-lowering drug classes. The annual prevalence of glucose-lowering drug users increased more than twofold from 19 per 1,000 inhabitants in 1999 (n=98,362) to 41 per 1,000 in 2014 (n=233,230). Metformin use increased more than sevenfold during the period and was used by 30 of 1,000 inhabitants in 2014, while the prevalence of insulin use increased 1.8-fold to 13 per 1,000 in 2014. After peaking in 2007, use of sulfonylurea halved to 6 per 1,000 in 2014. Newer drug classes including the glucagon-like peptide 1 receptor agonists, the dipeptidylpeptidase-4 inhibitors, and the sodium-glucose cotransporter 2 inhibitors had reached a considerable position by 2014, with 4 per 1,000, 6 per 1,000, and 0.8 per 1,000 inhabitants, respectively; however, the use of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in elderly people remained low. Thiazolidinediones decreased to virtually no use (0.03 per 1,000) in 2014. The use of glucose-lowering drugs has doubled during 1999-2014. The pattern of glucose-lowering drug use has changed substantially reflecting the recommendations of metformin as first-line treatment. The newer glucose-lowering drug classes have been well received.