Premium
Long‐term sustainability of glycaemic achievements with second‐line antidiabetic therapies in patients with type 2 diabetes: A real‐world study
Author(s) -
Montvida Olga,
Shaw Jonathan E.,
Blonde Lawrence,
Paul Sanjoy K.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13288
Subject(s) - type 2 diabetes , metformin , medicine , insulin , logistic regression , diabetes mellitus , glucagon like peptide 1 , glycated haemoglobin , endocrinology , gastroenterology , pharmacology
Aims To inform patients and their carers about both the probability of reducing glycated haemoglobin (HbA1c) to clinically desirable levels and the sustainability of such control over 2 years with major second‐line antidiabetic therapies, in individual risk scenarios, with and without third‐line intensification. Materials and Methods From US Centricity Electronic Medical Records, 163 081 patients with type 2 diabetes aged 18 to 80 years, who had initiated metformin, intensified their treatment with dipeptidyl peptidase‐4 (DPP‐4) inhibitors, glucagon‐like peptide‐1 (GLP‐1) receptor agonists (GLP‐1RAs), sulphonylureas (SUs), insulin or thiazolidinediones (TZDs), and continued second‐line treatment for ≥6 months, were selected. Treatment groups were balanced with regard to baseline characteristics, and glycaemic achievements were estimated using logistic regression analysis. Results With HbA1c concentrations of 58–63.9 mmol/mol (7.5–7.9%) at second‐line treatment initiation, the adjusted probabilities of achieving HbA1c <53 mmol/mol (<7%) at 6 months were 32%, 38%, 39%, 26% and 38% in the SU, DPP‐4 inhibitor, GLP‐1RA, insulin and TZD groups, respectively, while with baseline HbA1c concentrations of 64–75 mmol/mol (8–9%), the corresponding probabilities of reducing HbA1c to <58 mmol/mol (<7.5%) were 38%, 44%, 40%, 34% and 42%, respectively. In these baseline HbA1c categories, the adjusted probabilities of sustaining HbA1c achievements over 2 years were higher in the GLP‐1RA and TZD groups, compared with the SU and insulin groups ( P < .01). With baseline HbA1c concentrations of 75.1–108 mmol/mol (9.1–12%) 38% of patients achieved an HbA1c concentration <58 mmol/mol (<7.5%) at 6 months. The adjusted probability of sustaining this control over 2 years was higher in the incretin and TZD groups (range 62%‐75%), while insulin and SUs offered lower chances of sustainable control (range 54%‐56%). Conclusions Patients treated with second‐line incretins and TZDs had a significantly higher probability of achieving and sustaining glycaemic control over 2 years without further intensification, compared with those treated with SUs or insulin.