HbA1c Trends with Treatment Intensification following Inadequate Response to Two Oral Agents in Patients with Type 2 Diabetes

Abstract

Objectives: To describe HbA1c trends 1-year post treatment intensification to insulin or non-insulin agents in patients with insufficient HbA1c control while on 2 oral antidiabetic agents (2 OADs). Methods: A retrospective cohort study was conducted in a regional health plan claims database from 1/1/2010 to 3/31/2017. Included patients had type 2 diabetes (T2D) and their treatment was intensified with insulin, a GLP-1 receptor agonist (GLP-1RA) or a 3rd OAD within a year from an HbA1c ≥7.0% while on 2 OADs. HbA1c was estimated monthly by intensification with insulin or non-insulin (i.e., GLP-1RA and 3rd OAD) agents using a mixed-effect model. Results: The study analyzed a total of 3,909 HbA1c measures from 1,226 patients. HbA1c reductions were significant, but most patients continued to have inadequate glycemic control (HbA1c ≥7.0%). Those receiving insulin had a higher baseline HbA1c (p<0.01), but showed more substantial HbA1c decrease vs. those intensified with a non-insulin agent (p<0.01), controlling for baseline HbA1c. Conclusion: In patients with T2D, intensification following suboptimal glycemic control while on 2 OADs was associated with significant improvement in HbA1c control. Insulin intensification was associated with worse control at baseline, but greater HbA1c reduction than non-insulin intensification. Additional opportunity exists to improve glycemic control. Disclosure K. Kim: None. S. Unni: Research Support; Self; AstraZeneca, Sanofi-Aventis. D. Brixner: Research Support; Self; Sanofi. S. Thomas: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. C.J. Olsen: None. K.L. Sterling: Employee; Self; Sanofi. Stock/Shareholder; Self; Eli Lilly and Company. M. Mitchell: None. C. McAdam-Marx: Research Support; Self; AstraZeneca, Sanofi.