Pharmacologic Treatment of Type 2 Diabetes in the U.S., Sweden, and Israel

Beini Lyu, Yingying Sang, Elizabeth Selvin, Alex R. Chang, G. Caleb Alexander, Cheli Melzer Cohen, Josef Coresh, Varda Shalev, Gabriel Chodick, Avraham Karasik, Juan Jesus Carrero, Edouard L. Fu, Yang Xu, Morgan E. Grams, Jung Im Shin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVE To characterize and compare glucose-lowering medication use in type 2 diabetes in the U.S., Sweden, and Israel, including adoption of newer medications and prescribing patterns. RESEARCH DESIGN AND METHODS We used data from the National Health and Nutrition Examination Survey (NHANES) from the U.S., the Stockholm CREAtinine Measurements (SCREAM) project from Sweden, and Maccabi Healthcare Services (Maccabi) from Israel. Specific pharmaco-therapy for type 2 diabetes between 2007 and 2018 was examined. RESULTS Use of glucose-lowering medications among patients with type 2 diabetes was substantially lower in NHANES and SCREAM than in Maccabi (66.0% in NHANES, 68.4% in SCREAM, and 88.1% in Maccabi in 2017–2018). Among patients who took at least one glucose-lowering medication in 2017–2018, metformin use was also lower in NHANES and SCREAM (74.1% in NHANES, 75.9% in SCREAM, and 92.6% in Maccabi) whereas sulfonylureas use was greater in NHANES (31.5% in NHANES, 16.0% in SCREAM, and 14.9% in Maccabi). Adoption of dipeptidyl pepti-dase 4 inhibitors and sodium–glucose cotransporter 2 inhibitors (SGLT2i) was slower in NHANES and SCREAM than in Maccabi. History of atherosclerotic cardiovascular disease, heart failure, reduced kidney function, or albuminuria was not consistently associated with greater use of SGLT2i or glucagon-like peptide 1 receptor agonists (GLP1RA) across the three countries. CONCLUSIONS There were substantial differences in real-world use of glucose-lowering medications across the U.S., Sweden, and Israel, with more optimal pharmacologic management in Israel. Variation in access to care and medication cost across countries may have contributed to these differences. SGLT2i and GLP1RA use in patients at high risk was limited in all three countries during this time period.

Original languageEnglish
Pages (from-to)2926-2934
Number of pages9
JournalDiabetes Care
Issue number12
StatePublished - Dec 2022


FundersFunder number
National Institutes of Health
National Heart, Lung, and Blood InstituteK24HL152440
National Institute of Diabetes and Digestive and Kidney DiseasesR01DK115534, K01DK121825, K24HL155861
Nederlandse Organisatie voor Wetenschappelijk Onderzoek


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