Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting

摘要

Aim To assess glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on ≥2 non‐insulin antidiabetic drugs (NIADS). Methods A retrospective cohort study, using electronic health records from the SIDIAP database (2010–2014), was conducted. Intensification was defined as the prescription of any new antidiabetic drug in patients treated with ≥2 NIADS and HbA1c 7%. The primary outcome was the absolute change in HbA1c 6–12?months after any intensification. Secondary analyses included the percentage of patients reaching HbA1c 7%, HbA1c 8%, and a reduction of HbA1c 1% after the first intensification. Results There were 21?241 intensifications in 15?205 patients with a mean (SD) HbA1c of 9.02% (±1.35). Insulin and dipeptidyl peptidase‐4 inhibitors (DPP4i) were the most frequently added therapies. The mean baseline‐adjusted HbA1c reduction was 0.78% (95% CI, ?0.80 to ?0.76), varying from ?0.69% with DPP4i to ?0.85% with glucagon‐like peptide‐1 receptor agonists while the addition of insulin was associated with a reduction 1%. After the first intensification, 48.9% of patients achieved HbA1c 8%, 16.2% HbA1c 7%, and 43.1% a reduction 1%. High previous HbA1c was positively associated with the reduction of HbA1c 1% [odds ratio (OR) 2.13 (95% CI: 2.05–2.21)], but inversely associated with the attainment of HbA1c 7% [OR 0.64 (0.61–0.67)] or??8% [OR 0.63 (0.60–0.65)]. Older age, male gender, higher Charlson index, and short diabetes duration were associated with achievement of HbA1c 7%. Conclusions Despite intensification, most patients failed the glycaemic goal of HbA1c 7%. The reduction depended mainly on preintensification HbA1c values, with small differences between drugs.