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.