Trends in glycemic control in patients with insulin therapy compared with non-insulin or no drugs in type 2 diabetes in Japan: a long-term view of real-world treatment between 2002 and 2018 (JDDM 66). Issue 3 (3rd May 2022)

• Record Type: Journal Article
• Authors: Yokoyama, Hiroki; Araki, Shin-ichi; Yamazaki, Katsuya; Kawai, Koichi; Shirabe, Shin-Ichiro; Oishi, Mariko; Kanatsuka, Azuma; Yagi, Noriharu; Kabata, Daijiro; Shintani, Ayumi; Maegawa, Hiroshi
• Other Names: author non-byline.; Hasegawa Atsushi author non-byline.; Kato Masakazu author non-byline.; Kurihara Yoshio author non-byline.; Manda Naoki author non-byline.; Miyazawa Kazuhiro author non-byline.; Moriai Tetsuya author non-byline.; Tsuchida Kenichi author non-byline.; Yamada Daishiro author non-byline.; Yokoyama Hiroki author non-byline.; Yoshimura Haruhiko author non-byline.; Nakazono Makoto author non-byline.; Ishigaki Yasushi author non-byline.; Takahashi Yoshihiko author non-byline.; Okuguchi Fuminobu author non-byline.; Yamaguchi Hiroshi author non-byline.; Ajihara Takashi author non-byline.; Osonoi Takeshi author non-byline.; Saito Miyoko author non-byline.; Yamazaki Katsuya author non-byline.; Kawai Koichi author non-byline.; Ko Shigetake author non-byline.; Nakamura Susumu author non-byline.; Tsuruoka Akira author non-byline.; Uchida Daigaku author non-byline.; Kato Mitsutoshi author non-byline.; Takamura Hiroshi author non-byline.; Tomonaga Osamu author non-byline.; Ueki Akio author non-byline.; Hirao Koichi author non-byline.; Iemitsu Kotaro author non-byline.; Kanamori Akira author non-byline.; Maeda Hajime author non-byline.; Takai Masahiko author non-byline.; Takeda Hiroshi author non-byline.; Takaki Masato author non-byline.; Suzuki Hikari author non-byline.; Kono Yuki author non-byline.; Kato Sumio author non-byline.; Hayashi Hiroshi author non-byline.; Kashiwagi Atsunori author non-byline.; Maegawa Hiroshi author non-byline.; Miyazawa Ituko author non-byline.; Hosokawa Akiko author non-byline.; Noto Takashi author non-byline.; Iwasaki Koichi author non-byline.; Iwamoto Masahiro author non-byline.; Minami Masae author non-byline.; Ninomiya Hiroshi author non-byline.; Tanaka Kokichi author non-byline.; Yokomizo Yoshifumi author non-byline.; Yamaguchi Kohei author non-byline.; Abe Katsushige author non-byline.; Abe Nobuyuki author non-byline.; Yano Nobuki author non-byline.; Chosa Michiko author non-byline.; Yagi Noriharu author non-byline.; Arakaki Takako author non-byline.;
• Is Part Of: BMJ open diabetes research and care. Volume 10:Issue 3(2022)
• Publication Date: 2022-05-03
• Subjects: diabetes mellitus, type 2 -- drug therapy -- insulin; Diabetes -- Periodicals; 616.462005
• DOI: 10.1136/bmjdrc-2021-002727
• Languages: English
• ISSNs: 2052-4897

Abstract

Abstract : Introduction: We investigated trends in the proportion of diabetes treatment and glycemic control, which may be altered by recent advances in insulin and non-insulin drugs, in Japanese patients with type 2 diabetes. Research design and methods: A serial cross-sectional study was performed using a multicenter large-population database from the Japan Diabetes Clinical Data Management study group. Patients with type 2 diabetes who attended clinics belonging to the study group between 2002 and 2018 were included to examine trends in glycated hemoglobin A1c (HbA1c) by treatment group using multivariable non-linear regression model. Results: The proportion of patients with insulin only decreased from 15.0% to 3.6%, patients with insulin+non-insulin drugs increased from 8.1% to 15.1%, patients with non-insulin drugs increased from 50.8% to 67.0%, and those with no drugs decreased from 26.1% to 14.4% from 2002 to 2018, respectively. The HbA1c levels of each group, except for no drugs, continued to decrease until 2014 (unadjusted mean HbA1c (%) from 2002 to 2014: from 7.89 to 7.45 for insulin only, from 8.09 to 7.63 for insulin+non-insulin, and from 7.51 to 6.98 for non-insulin) and remained unchanged thereafter. Among insulin-treated patients, use of human insulin decreased, use of long-acting analog insulin increased, and concomitant use of non-insulin drugs increased (from 35.1% in 2002 to 80.9% in 2018), which included increased use of dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists, and the persistently high use of metformin. Conclusions: During the past two decades, combined use of insulin and non-insulin drugs increased and glycemic control improved and leveled off after 2014 in Japanese patients with type 2 diabetes. Further studies of the trend in association with age and factors related to metabolic syndrome are necessary to investigate strategies aiming at personalized medicine in diabetes care.