Use of sodium‐glucose cotransporter‐2 inhibitors in France: Analysis of French nationwide health insurance database

Aim Sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i) have been commercialized in France for type 2 diabetes since April 2020 and later for heart and renal diseases. Given the recent developments in treating diabetes and the widening of SGLT‐2i indications, we aimed to study changes in the use of glucose‐lowering drugs in France and to characterize SGLT‐2i new users. Methods We performed a nationwide utilization study using the French health insurance database. Trends in incidence and prevalence of glucose‐lowering drug use were assessed by a repeated cross‐sectional study in 2019 and 2021. A cohort study of incident SGLT‐2i users was then conducted to describe patient characteristics and the strategy for treating diabetes. Results The prevalence of SGLT‐2i use gradually reached 0.1% in the third quarter of 2021 and increased more significantly to 0.2% thereafter. SGLT‐2i became the second most prescribed glucose‐lowering drug class after metformin at the end of 2021 (0.1%). Among the cohort of 125 387 SGLT‐2i new users (mean age 65.0 years; 60.1% of men), 87.6% presented a diabetic comorbidity. The patient profile changed over the study period with an increasing proportion of patients with cardiovascular (28.7% in 2020 vs. 40.2% in 2021) or renal (7.7% in 2020 vs. 11.8% in 2021) comorbidities at initiation. The main combinations used at SGLT‐2i initiation were metformin (12.5%) and metformin plus dipeptidyl peptidase‐4 inhibitors (8.1%). One‐year probability of SGLT‐2i persistence was estimated to be 55%. Conclusion The expansion of indications for SGLT‐2i and the broadening of the target population make it essential to assess the reasons for discontinuation and review their safety profile.