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. Issue 6 (19th March 2019)

• Record Type: Journal Article
• Authors: Canivell, Silvia; Mata‐Cases, Manel; Real, Jordi; Franch‐Nadal, Josep; Vlacho, Bogdan; Khunti, Kamlesh; Gratacòs, Mònica; Mauricio, Dídac
• Is Part Of: Diabetes, obesity & metabolism. Volume 21:Issue 6(2019)
• Page Start: 1373
• Page End: 1380
• Publication Date: 2019-03-19
• Subjects: glycaemic control -- intensification -- observational -- type 2 diabetes mellitus; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.13663
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract : 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.