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
Por:
Canivell, S, Mata-Cases, M, Real, J, Franch-Nadal, J, Vlacho, B, Khunti, K, Gratacos, M, Mauricio, D
Publicada:
1 jun 2019
Resumen:
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 Despite intensification, most patients failed the glycaemic goal of HbA1c <7%. The reduction depended mainly on preintensification HbA1c values, with small differences between drugs.
Filiaciones:
Canivell, S:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Catala Salut, Primary Hlth Care Ctr St Marti de Provencals, Gerencia Atencio Primaria, Barcelona, Spain
Hlth Sci Res Inst, Dept Internal Med, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Mata-Cases, M:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr La Mina, Gerencia Ambit Atencio Primaria Barcelona Ciutat, St Adria De Besos, Spain
Real, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Franch-Nadal, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr Raval Sud, Gerencia Atencio Primaria, Barcelona, Spain
Vlacho, B:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
Khunti, K:
Univ Leicester, Diabet Res Ctr, Leicester, Leics, England
Gratacos, M:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
Mauricio, D:
Fundacio Inst Univ Recerca Atencio Primaria Salut, DAP Cat Grp, Unitat Suport Recerca Barcelona, Barcelona, Spain
ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Autonomous Univ Barcelona, Hosp Univ Santa Creu & St Pau, Dept Endocrinol & Nutr, Barcelona, Spain
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