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- Title
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.
- Authors
Vlacho, Bogdan; Gratacòs, Mònica; Canivell, Silvia; Real, Jordi; Mata‐Cases, Manel; Franch‐Nadal, Josep; Mauricio, Dídac; Khunti, Kamlesh
- 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.
- Subjects
TYPE 2 diabetes treatment; GLYCEMIC control; HYPOGLYCEMIC agents; HEALTH outcome assessment; COHORT analysis
- Publication
Diabetes, Obesity & Metabolism, 2019, Vol 21, Issue 6, p1373
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.13663