A retrospective analysis of the fasting plasma glucose and glycosylated hemoglobin and pharmacotherapy change patterns among type 2 diabetes mellitus patients

Abstract

Objective: The aim of this study was to describe glycemic control levels (fasting plasma glucose [FPG] and glycosylated hemoglobin [HbA1c]) and pharma-cotherapy change patterns among a cohort of patients with type 2 diabetes mellitus (T2DM) receiving various antidiabetic agents.Methods: This study, a retrospective analysis conducted from a large electronic medical record database, identified T2DM patients with ≥1 prescription for metformin, sulfonylureas, or thiazolidinediones from January 23, 1997, through March 15, 2006. The database contained medical and clinical records of patients–including diagnoses, medications, laboratory results, and physician orders–linked through encrypted patient identifiers. This study calculated the mean and median FPG and HbA1c values (performed within 30 days before or after a pharmacotherapy change) and the percentage of patients with values above those recommended by the American Diabetes Association (ADA) and the American College of Endocrinology (ACE)/American Association of Clinical Endocrinologists(AACE).Results: The study included a total of 7769 T2DM patients (3942 female/3827 male; 56.9% were aged 50–69 years). For patients with no pharmacotherapy change, most did not achieve the ADA recommendations for FPG (56.4% [1917/3398]) or HbA1c (48.6% [952/1958]) or the ACE/AACE recommendations forFPG (79.4% [2698/3398]) or HbA1c (65.4% [1281/1958]). These patients' mean FPG level was 151.9 mg/ dL (95% CI, 150.0–153.9 mg/dL) and their mean HbA1c value was 7.51% (95% CI, 7.43%–7.60%). For patients with a pharmacotherapy change, the mean FPG level was 191.1 mg/dL (95% CI, 186.7–195.4 mg/dL) and the mean HbA1c value was 8.85% (95% CI, 8.70%–9.00%). Similar to those with no pharmacotherapy change, a large percentage of patients with a pharmacotherapy change did not achieve the ADA recommendations for FPG (77.7% [1107/1425]) or HbA1c (76.2% [753/988]) or the ACE/AACE recommendations for FPG (90.1% [1284/1425]) or HbA1c (88.5% [874/988]).Conclusion: Despite the proven benefits of maintaining glycemic control and its impact on reducing long-term risk of diabetes complications, these results indicate that the mean FPG and HbA1c values for a large percentage of diabetic patients included in this study remained above those recommended by the ADA and the ACE/AACE.