Study identifies potential prescribing cascades in adults with type 2 diabetes

Two parallel cohort studies used routine data from Scotland and Wales to examine whether selected diabetes and cardiovascular medicines were followed by treatments for potential adverse drug reactions. Seven of 12 medication pairs showed evidence of a possible prescribing cascade among more than 680,000 adults with type 2 diabetes.

Seven of 12 medication pairs showed potential cascades.
SGLT2 inhibitors were followed by more antifungal prescribing.
Data came from routine Scottish and Welsh healthcare databases.
Sequence patterns do not establish causality.

Researchers analysed prescribing records from the Scottish Diabetes Research Network and the Welsh Secure Anonymised Information Linkage Databank for January 2015 to December 2023. The two parallel cohort studies included adults aged 40 years or older with type 2 diabetes who started both an index medicine and a corresponding marker medicine within 365 days. Prescription sequence symmetry analysis compared whether the marker medicine was started after, rather than before, the index medicine; results were pooled across datasets.

Seven of 12 medication pairs showed evidence of potential cascades. After sodium-glucose cotransporter-2 (SGLT2) inhibitor initiation, subsequent use was more frequent for antifungals (adjusted sequence ratio 1.64, 95% CI 1.58–1.69), urinary tract infection antibiotics (1.14, 1.10–1.17), and overactive bladder medicines (1.16, 1.00–1.34). Other signals included thiazolidinediones followed by loop diuretics (2.23, 1.28–3.89), and statins followed by hypnotics (1.45, 1.29–1.62). The analysis included 387,338 people in Scotland and 296,582 in Wales.

The findings may help clinicians consider whether a new symptom and subsequent prescription could reflect an adverse effect of an existing medicine. However, sequence patterns indicate potential cascades, not confirmed drug-related events or causality; the study does not establish that stopping or changing a medicine would be appropriate for an individual patient.

In practice

For adults aged 40 years or older with type 2 diabetes, the findings identify medication pairs that may warrant consideration during medication review, including SGLT2 inhibitors followed by antifungals or urinary tract infection antibiotics. The study used prescription sequences in routine data from Scotland and Wales and included more than 680,000 people. These associations indicate potential prescribing cascades, not confirmed adverse drug reactions or causal effects; they do not establish that a medicine should be stopped or changed, and individual clinical assessment remains necessary.

AI-generated clinical interpretation · Not editor-reviewed

AI summary · Not yet editor-reviewed

Is this summary clinically accurate?

Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.

Source

BMC Medicine: Prescribing cascades in people with type 2 diabetes: analyses of two representative routine healthcare databases ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.