Degree of control and delayed intensification of antihyperglycaemic treatment in type 2 diabetes mellitus patients in primary care in Spain

Abstract

Objectives Primary aim: to determine the degree of control of HbA 1c at the time of treatment intensification (TI) in T2DM patients. Secondary aims: fasting plasma glucose levels; estimation of the elapsed time between HbA 1c exceeding 7% and TI; antidiabetic combinations used, % patients with good cardiometabolic control (LDL-c < 100 mg/dL; SBP < 130 and DPB < 80 mmHg and HbA 1c < 7%). Research design and methods One-cohort, multicenter, retrospective, observational study conducted in Spain. Patients diagnosed with T2DM that had switched from monotherapy to combination antidiabetic therapy were evaluated at baseline and after one year of follow-up. Results A total of 1202 T2DM patients were analyzed. At the time of TI: mean HbA 1c 8.1%; median time of uncontrolled disease: 2.0 years. After one-year of TI: significant reduction in mean HbA 1c (8.1% vs.7.0%, p < 0.001) and a mean fasting plasma glucose levels reduction (181.1 mg/dL vs.144.1 mg/dL, p < 0.001) was also observed. The percentage of patients under glycemic control (HbA 1c < 7%) increased from 12.2% to 51.6% ( p < 0.001). Most common antidiabetic combinations: metformin + sulfonylurea (44.1%) and metformin + thiazolidindione (15.9%). Conclusions In the population of T2DM patients analyzed, TI was carried out when HbA 1c values were above those recommended in clinical guidelines (≤7%), with a delay of two years to address the second step of therapy, despite the consensus recommendation of the ADA/EASD of 3 months. TI was shown to be effective since addition of a second antidiabetic drug led to an average reduction of HbA 1c of approximately 1%. Metformin was the drug most commonly used as monotherapy being the most frequent combination metformin + sulfonylurea.