Abstract
AimsLess strict glycated hemoglobin (HbA1c) thresholds have been recommended in older and/or frail type 2 diabetes (T2D) patients than in younger and less frail patients for initiating hypoglycemic agents since 2011. We aimed to assess trends in HbA1c thresholds at initiation of a first hypoglycemic agent(s) in T2D patients and the influence of age and frailty on these trends.Materials and methodsThe groningen initiative to analyze type 2 diabetes treatment (GIANTT) database was used, which includes primary care T2D patients from the north of the Netherlands. Patients initiating a first non‐insulin hypoglycemic agent(s) between 2008 and 2014 with an HbA1c measurement within 120 days before initiation were included. The influence of calendar year, age, or frailty and the interaction between calendar year and age or frailty were assessed using multilevel regression analyses adjusted for confounders.ResultsWe included 4588 patients. The mean HbA1c threshold at treatment initiation was 7.4% up to 2010, decreasing to 7.1% in 2011 and increasing to 7.4% in 2014. This quadratic change over the years was significant (P < 0.001). Patients aged 60 to 79 initiated treatments at lower HbA1c and patients of different frailty at similar HbA1c levels. The interaction between year and age or frailty was not significant (P > 0.05).ConclusionsHbA1c thresholds at initiation of a first hypoglycemic agent(s) changed significantly over time, showing a decrease after 2010 and an increase after 2012. The HbA1c threshold at initiation was not influenced by age or frailty, which is in contrast with recommendations for more personalized treatment.
Highlights
An important goal of type 2 diabetes (T2D) management is reducing the risk of complications by good control of blood glucose levels
The number of patients in each calendar year differed, whereas the patient characteristics were similar over the years (Supplementary Table 2 in Data S1)
The rising trend in HbA1c level at treatment initiation after 2012 is not in line with our hypothesis, since we expected a decrease in the overall HbA1c threshold throughout the study period
Summary
An important goal of type 2 diabetes (T2D) management is reducing the risk of complications by good control of blood glucose levels. From 2011 onwards, guidelines recommended HbA1c targets ≤7.0% for non-frail patients younger than 70 years and between 7.0% and 8.5% for many patients older than 70 years with a longer diabetes duration and/or frail patients[9,11,12,13] (Supplementary Table 1 in Data S1). These targets are considered as thresholds for initiating treatment. The extent to which these recommendations have led to more personalized initiation of hypoglycemic treatment in clinical practice is unknown
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