Abstract
BackgroundIn cases where antidiabetic monotherapy is unable to sufficiently control glucose levels in patients with type-2 diabetes, treatment needs to be intensified. Determining factors that may be predictors for the occurrence of comorbidities in these patients is essential for improving the efficacy of clinical diabetes care.MethodsThe DiaRegis prospective cohort study included 3,810 type-2 diabetics for whom the treating physician aimed to intensify and optimise antidiabetic treatment due to insufficient glucose control. Treatment intensification was defined as increasing the dose of the originally prescribed drug, and/or selecting an alternative drug, and/or prescribing an additional drug. The aims were to monitor the co-morbidity burden of type-2 diabetic patients over a follow-up of two years, and to identify multivariable adjusted predictors for the development of comorbidity and cardiovascular events.ResultsA total of 3,058 patients completed the 2 year follow-up. A substantial proportion of these patients had co-morbidities such as vascular disease, neuropathy, and heart failure at baseline. After treatment intensification, there was an increased use of DPP-4 inhibitors, insulin, and GLP-1 analogues, achieving reductions in HbA1c, fasting plasma glucose, and postprandial glucose. During the 2 year period 2.5% of patients (n = 75) died, 3.2% experienced non-fatal macrovascular events, 11.9% experienced microvascular events, and 4.3% suffered onset of heart failure. Predictors for combined macro-/microvascular complications/heart failure/death were found to be age (OR 1.36; 95% CI 1.10–1.68), prior vascular disease (1.73; 1.39–2.16), and history of heart failure (2.78; 2.10–3.68).ConclusionsDetermining the factors that contribute to co-morbidities during intensive glucose-lowering treatment is essential for improving the efficacy of diabetes care. Our results indicate that age, prior vascular disease, and heart failure constitute important predictors of poor cardiovascular outcomes in patients receiving such therapy.
Highlights
In cases where antidiabetic monotherapy is unable to sufficiently control glucose levels in patients with type-2 diabetes, treatment needs to be intensified
Treatment escalation is left to the discretion of the consulting physician, with a variety of options available, including changes in the drug being administered or prescribing additional oral antidiabetic drugs (OADs)
Within the 12 months prior to inclusion into DiaRegis, 1.4% of patients had experienced an episode of severe hypoglycaemia
Summary
In cases where antidiabetic monotherapy is unable to sufficiently control glucose levels in patients with type-2 diabetes, treatment needs to be intensified. Any treatment decision should consider the patient’s particular characteristics and specific treatment goals, as well as the economic aspects [5] This approach, diminishes the utility of pre-defined treatment goals and drug selection algorithms, instead favouring a treatment strategy that meets the needs of individual patients. In this regard, the European Association for the Study of Diabetes (EASD) in partnership with the American Diabetes Association (ADA) [3] and the European Society of Cardiology (ESC) [6] have provided guidelines for more patient-centred care strategies for type-2 diabetics. These guidelines are less prescriptive than prior algorithms, and owing to the lack of evidence-based inferences, their ultimate value will only become clear with comparative studies that assess real-world outcomes
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