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- Title
Durability of glycaemic control in patients with type 2 diabetes after metformin failure: Prognostic model derivation and validation using the DISCOVER study.
- Authors
Ling, Suping; Sun, Ping; Zaccardi, Francesco; Khosla, Sajan; Cooper, Andrew; Fenici, Peter; Khunti, Kamlesh
- Abstract
Aim: To develop and internally validate prognostic models on the long‐term durability of glycaemic control in patients with type 2 diabetes after metformin failure. Materials and Methods: DISCOVER is a 3‐year, prospective observational study across six continents investigating second‐line glucose‐lowering therapies. In this analysis from 35 countries, we included patients on metformin initiating second‐line glucose‐lowering medication(s) because of physician‐defined lack of efficacy. The outcome was durability of glycaemic control, defined as three consecutive levels of HbA1c at 6‐, 12‐ and 24‐month follow‐up at target (HbA1c equal to or lower than the level when the physician initiated the second‐line therapy in patients with baseline HbA1c ≤7% [53 mmol/mol]; and equal to or lower than 7% in those with baseline HbA1c >7%). We developed and internally validated two prognostic models: a base model, which included age, sex, ethnicity, country income group, baseline HbA1c and second‐line therapy, and an advanced model, established through statistical variable selections from a model including base variables and 13 additional predictors selected from a literature review. We used logistic regression to develop and 500 bootstrapping samples to internally validate the models; discrimination and calibration were used to assess model performance. Results: Overall, 896 out of 2995 participants (29.9%) had sustained glycaemic control. The base model performed well: Nagelkerke R2 was 0.13, C‐index 0.70 (95% CI: 0.68, 0.71) and bias‐corrected C‐index 0.69 after internal validation. Diabetes duration, insurance type, estimated glomerular filtration rate and glucose self‐monitoring were additionally selected in the advanced model, which had only a slightly better performance compared with the base model: Nagelkerke R2 0.20, C‐index 0.71 (95% CI: 0.69, 0.73) and bias‐corrected C‐index 0.70. Calibration plots showed good calibrations of both validated models. Conclusion: These prognostic models, which include simple demographic and routinely collected clinical information, enabled the estimation of the probability of 2‐year sustained glycaemic control in patients after metformin failure. The models have been implemented into a web‐based tool to support healthcare professionals in their decisions.
- Subjects
GLYCEMIC control; METFORMIN; TYPE 2 diabetes; MODEL validation; MEDICAL personnel; GLOMERULAR filtration rate
- Publication
Diabetes, Obesity & Metabolism, 2020, Vol 22, Issue 5, p828
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.13966