Early glycaemic control among patients with type 2 diabetes and initial glucose‐lowering treatment: a 13‐year population‐based cohort study

Aim To examine real‐life time trends in early glycaemic control in patients with type 2 diabetes between 2000 and 2012. Methods We used population‐based medical databases to ascertain the association between achievement of glycaemic control with initial glucose‐lowering treatment in patients with incident type 2 diabetes in N orthern D enmark. Success in reaching glycated haemoglobin ( HbA1c ) goals within 3–6 months was examined using regression analysis. Results Of 38 418 patients, 91% started with oral glucose‐lowering drugs in monotherapy. Metformin initiation increased from 32% in 2000–2003 to 90% of all patients in 2010–2012. Pretreatment (interquartile range) HbA1c levels decreased from 8.9 (7.6–10.7)% in 2000–2003 to 7.0 (6.5–8.1)% in 2010–2012. More patients achieved an HbA1c target of <7% (<53 mmol/mol) in 2010–2012 than in 2000–2003 [80 vs 60%, adjusted relative risk ( aRR ) 1.10, 95% confidence interval ( CI ) 1.08–1.13], and more achieved an HbA1c target of <6.5% [(<48 mmol/mol) 53 vs 37%, aRR 1.07 95% CI 1.03–1.11)], with similar success rates observed among patients aged <65 years without comorbidities. Achieved HbA1c levels were similar for different initiation therapies, with reductions of 0.8% (from 7.3 to 6.5%) on metformin, 1.5% (from 8.1 to 6.6%) on sulphonylurea, 4.0% (from 10.4 to 6.4%) on non‐insulin combination therapies, and 3.8% (from 10.3 to 6.5%) on insulin monotherapy. Conclusions Pretreatment HbA1c levels in patients with incident type 2 diabetes have decreased substantially, which is probably related to earlier detection and treatment in accordance with changing guidelines. Achievement of glycaemic control has improved, but 20% of patients still do not attain an HbA1c level of <7% within the first 6 months of initial treatment.