Oral Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Oral Hypoglycemic Agents use in Australian women of reproductive age: Implications for unplanned pregnancies (#22)

Farah Naz Hashmani 1 , Arianne Sweeting 2 3 , Kirsten Black 2 4 , Jenni Ilomaki 5 6 , Luke Grzeskowiak 6 7 8
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Department of Endocrinology , Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. Sydney Local Health District, Sydney, NSW, Australia
  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  6. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, , Monash University, Parkville, Victoria, Australia
  7. College of Medicine & Public Health , Flinders University , Bedford Park , South Australia, Australia
  8. South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia

 

Background:  The prevalence of Type 2 diabetes among reproductive-aged women is increasing globally1. Several new oral hypoglycaemic agents (OHA) are now available for the management of type 2 diabetes but little is known about their uptake in women of reproductive age which is important given the lack of safety data in pregnancy.

Aims: To examine longitudinal trends in the prevalence of OHA use among reproductive-aged women in Australia between 2013 and 2021 and explore concurrent use of long-acting reversible contraceptives (LARCs) and other hormonal contraceptives at the time of first prescribing OHA (as a proxy of risk for unintended pregnancy).

Methods: We conducted a retrospective population-based study using Pharmaceutical Benefits Scheme (PBS) dispensing claims of a 10% random sample of females aged between 15-49 years with a dispensing claim for OHA. Prevalence was determined as the prescribing of at least one OHA within a class in a given year, calculated using population data from the Australian Bureau of Statistics (ABS) within each state/territory, and presented as a rate per 1000 women aged 15-49 years. Concurrent hormonal contraceptive use was identified where the date of supply plus the likely duration of efficacy overlapped with the first dispensing date of OHA.

Results: The use of OHA has risen from 15.7/1000 in 2013 to 24.2/1000 in 2021. Metformin was the most frequently prescribed OHA (12.2/1000 in 2013 to 17.8/1000 in 2021). Significant increases were evident in the prevalence of SGLT-2 inhibitors (0/1000 in 2013 to 2.9/1000 in 2021) and Incretin mimetics (0.4/1000 in 2013 to 2.7/1000 in 2021). The most significant increases in SGLT-2 inhibitors and Incretin mimetics were observed among women aged > 35 years, varying by State/Territory.  Overall, 14.3% of women receiving an OHA for the first time were considered concurrent LARC users, with an additional 10% receiving other hormonal contraceptive methods. There was a statistically significant increase in the odds of having concurrent LARC usage for women dispensed alpha-glucosidase inhibitors (Odds Ratio (OR) 1.64 [95% Confidence Interval (CI) 1.12-2.39]), Incretin mimetics (OR 1.13 [95%CI 1.02-1.24]), and SGLT-2 inhibitors (AOR 1.09 [1.01-1.18]) when compared with biguanides, (adjusted for age, state, and concession status).

Conclusion: There is increasing use of newer classes of OHA such as SGLT-2 and incretin mimetics. While concurrent use of LARC appears higher among those prescribed newer OHAs that have less safety data during pregnancy, rates of LARC use remain low and raise potential concerns regarding the impacts of unplanned pregnancies in this setting. 

  1. International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation, 2021.