Premium
Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting
Author(s) -
Canivell Silvia,
MataCases Manel,
Real Jordi,
FranchNadal Josep,
Vlacho Bogdan,
Khunti Kamlesh,
Gratacòs Mònica,
Mauricio Dídac
Publication year - 2019
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.13663
Subject(s) - medicine , type 2 diabetes , insulin , diabetes mellitus , odds ratio , medical prescription , retrospective cohort study , cohort , endocrinology , pharmacology
Aim To assess glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on ≥2 non‐insulin antidiabetic drugs (NIADS). Methods A retrospective cohort study, using electronic health records from the SIDIAP database (2010–2014), was conducted. Intensification was defined as the prescription of any new antidiabetic drug in patients treated with ≥2 NIADS and HbA1c >7%. The primary outcome was the absolute change in HbA1c 6–12 months after any intensification. Secondary analyses included the percentage of patients reaching HbA1c <7%, HbA1c <8%, and a reduction of HbA1c >1% after the first intensification. Results There were 21 241 intensifications in 15 205 patients with a mean (SD) HbA1c of 9.02% (±1.35). Insulin and dipeptidyl peptidase‐4 inhibitors (DPP4i) were the most frequently added therapies. The mean baseline‐adjusted HbA1c reduction was 0.78% (95% CI, −0.80 to −0.76), varying from −0.69% with DPP4i to −0.85% with glucagon‐like peptide‐1 receptor agonists while the addition of insulin was associated with a reduction >1%. After the first intensification, 48.9% of patients achieved HbA1c <8%, 16.2% HbA1c <7%, and 43.1% a reduction >1%. High previous HbA1c was positively associated with the reduction of HbA1c >1% [odds ratio (OR) 2.13 (95% CI: 2.05–2.21)], but inversely associated with the attainment of HbA1c <7% [OR 0.64 (0.61–0.67)] or < 8% [OR 0.63 (0.60–0.65)]. Older age, male gender, higher Charlson index, and short diabetes duration were associated with achievement of HbA1c <7%. Conclusions Despite intensification, most patients failed the glycaemic goal of HbA1c <7%. The reduction depended mainly on preintensification HbA1c values, with small differences between drugs.