Longitudinal Trends in Non-Insulin Pharmacotherapy for Type 2 Diabetes in Australian Women of Reproductive Age: Implications for Planned and Unplanned Pregnancies.

PURPOSE: To (a) examine longitudinal trends in prescribing of first- and second-line non-insulin pharmacotherapies (NIPs) among reproductive-aged women in Australia between 2013 and 2021 and (b) explore concurrent use of highly effective long-acting reversible contraceptives (LARCs), as well as other hormonal contraceptives, at the time of first dispensing of NIP.

METHODS

Using a 10% random sample of Australian women aged 18-44 years from dispensing claims from the Pharmaceutical Benefits Scheme (PBS), the annual prescription of at least one NIP was reported as a rate per 1000 women. Concurrent LARC use was identified where the date of contraceptive supply plus the likely duration of efficacy overlapped with the first dispensing date of NIP.

RESULTS

The overall rate of NIP use has increased from 14.40 to 23.15/1000 women between 2013 and 2021, with increases observed in the rate of women prescribed the first-line agent metformin alone (11.94-18.41/1000), metformin and a second-line NIP (2.17-3.88/1000), and second-line NIP alone (0.29-0.85/1000). When compared with initiating treatment with metformin, the proportion of women considered concurrent LARC users or any contraceptive method was modestly higher for those commencing treatment with a second-line NIP (17.0% vs. 12.7% [aOR, 1.09, 95% CI: 1.02, 1.17] and 26.7% vs. 20.5% [aOR: 1.12, 95% CI: 1.05, 1.19], respectively).

CONCLUSION

There is increasing use of NIP amongst reproductive-aged women in Australia, with rates of use of second-line NIPs almost doubling between 2013 and 2021. While concurrent use of LARC appears higher among those prescribed second-line NIP, compared with metformin, rates of LARC use still appear low.