1. Early glycaemic control among patients with type 2 diabetes and initial glucose-lowering treatment: a 13-year population-based cohort study.
- Author
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Thomsen RW, Baggesen LM, Svensson E, Pedersen L, Nørrelund H, Buhl ES, Haase CL, and Johnsen SP
- Subjects
- Aged, Cohort Studies, Databases, Factual, Denmark, Diabetes Mellitus, Type 2 blood, Drug Therapy, Combination, Female, Glycated Hemoglobin metabolism, Humans, Insulin administration & dosage, Male, Middle Aged, Prospective Studies, Regression Analysis, Sulfonylurea Compounds administration & dosage, Treatment Outcome, Diabetes Mellitus, Type 2 drug therapy, Early Medical Intervention statistics & numerical data, Glycated Hemoglobin drug effects, Hypoglycemic Agents administration & dosage, Metformin administration & dosage
- Abstract
Aim: To examine real-life time trends in early glycaemic control in patients with type 2 diabetes between 2000 and 2012., Methods: We used population-based medical databases to ascertain the association between achievement of glycaemic control with initial glucose-lowering treatment in patients with incident type 2 diabetes in Northern Denmark. Success in reaching glycated haemoglobin (HbA1c) goals within 3-6 months was examined using regression analysis., Results: Of 38 418 patients, 91% started with oral glucose-lowering drugs in monotherapy. Metformin initiation increased from 32% in 2000-2003 to 90% of all patients in 2010-2012. Pretreatment (interquartile range) HbA1c levels decreased from 8.9 (7.6-10.7)% in 2000-2003 to 7.0 (6.5-8.1)% in 2010-2012. More patients achieved an HbA1c target of <7% (<53 mmol/mol) in 2010-2012 than in 2000-2003 [80 vs 60%, adjusted relative risk (aRR) 1.10, 95% confidence interval (CI) 1.08-1.13], and more achieved an HbA1c target of <6.5% [(<48 mmol/mol) 53 vs 37%, aRR 1.07 95% CI 1.03-1.11)], with similar success rates observed among patients aged <65 years without comorbidities. Achieved HbA1c levels were similar for different initiation therapies, with reductions of 0.8% (from 7.3 to 6.5%) on metformin, 1.5% (from 8.1 to 6.6%) on sulphonylurea, 4.0% (from 10.4 to 6.4%) on non-insulin combination therapies, and 3.8% (from 10.3 to 6.5%) on insulin monotherapy., Conclusions: Pretreatment HbA1c levels in patients with incident type 2 diabetes have decreased substantially, which is probably related to earlier detection and treatment in accordance with changing guidelines. Achievement of glycaemic control has improved, but 20% of patients still do not attain an HbA1c level of <7% within the first 6 months of initial treatment., (© 2015 John Wiley & Sons Ltd.)
- Published
- 2015
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