Evaluating glycaemic control in patients poorly controlled on oral antidiabetic drugs in real‐world setting: Results from assessing the Appropriate Timing of Type 2 diAbetes INtensification (ATTAIN)

摘要

Introduction Many patients with type 2 diabetes mellitus (DM) fail to achieve glycaemic control despite recommended treatment strategies to reduce glycated haemoglobin (HbA1c). This real‐world retrospective cohort study compared HbA1c change and treatment patterns between those intensifying and not intensifying therapy with oral antidiabetic drugs (OADs). Materials and methods Patients suboptimally controlled on OADs (58?mmol/mol [7.5%] or 64?mmol/mol [8.0%] for high risk, index 1) were included from IQVIA Medical Research Data. Intensifiers within 12?months of index 1 were matched (1:1) to nonintensifiers. Primary outcomes were HbA1c change and proportion of participants achieving HbA1c targets 6 and 12?months post‐index 2 (date of intensification [intensifiers] or pseudodate [nonintensifiers]). Therapy adherence was also assessed. Results A total of 10?832 participants (5539 intensifiers and 5293 nonintensifiers) were included. Mean HbA1c decrease from baseline to 6?months was ?1.13% (intensifiers) vs ?0.75% (nonintensifiers), with no substantial further change at 12?months. Cox proportional hazards (PH) analysis suggested a nearly 20% greater chance of target achievement at 6?months for intensifiers vs nonintensifiers (hazard ratio [HR]: 0.79 [95% confidence interval [CI]: 0.73‐0.86]), which was similar at 12?months (HR: 0.80 [95% CI: 0.74‐0.86]). Intensifiers tended towards greater adherence to baseline therapy (90% [standard deviation (SD): 14.9] vs nonintensifiers 87% [SD: 16.0]), which decreased following intensification. Conclusions Significant reductions in HbA1c were evident at 6?months and were greater in intensifiers vs nonintensifiers. Little additional clinical benefit was seen 12?months postintensification. Despite good treatment adherence, many participants failed to achieve target HbA1c; actions beyond improved adherence are needed to improve suboptimal HbA1c.