Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis

Abstract

We assessed global achievement of targets recommended by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and National Institute of Health and Care Excellence (NICE) for type 2 diabetes. We searched Medline, Embase, and The Cochrane Library for observational studies reporting target attainment (2006 to 2017 inclusive) for HbA1c, blood pressure, or lipids (low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], or triglycerides). Rates were pooled using a random-effects meta-analysis. Study quality and risk of small study of bias was assessed. From 2491 screened records, 24 studies were included reporting on 369,251 people from 20 countries. The pooled target achievement rates were; 42.8% (95% CI 38.1-47.5%) for glycaemic control, 29.0% (22.9-35.9%) for blood pressure, 49.2% (39.0-59.4%) for LDL-C, 58.2% (51.7-64.4%) for HDL-C, and 61.9% (55.2-68.2%) for triglyceride control. A higher proportion of people achieved HbA1c targets within Europe and North America than the rest of the world. A higher proportion of people achieved blood pressure targets in North America than Europe or the rest of the world. Meta regression showed no significant improvement in rates by year for any target. The achievement of evidence-based targets is markedly suboptimal globally and not improving.

Glycaemic control in the diabetes and Lifestyle Cohort Twente: A cross‐sectional assessment of lifestyle and pharmacological management on Hba1c target achievement

“…In this secondary care setting, the ideal target of <53 mmol/mol (<7%) was not reached in two‐thirds of patients (64%), which is somewhat higher than the reported worldwide pooled‐average (57%) 3. The latter report, however, also included less complicated type 2 diabetes mellitus populations.…”

“…In this secondary care setting, the ideal target of <53 mmol/mol (<7%) was not reached in two-thirds of patients (64%), which is somewhat higher than the reported worldwide pooled-average (57%). 3 The latter report, however, also included less complicated type 2 diabetes mellitus populations. In our population, median diabetes duration was 11 years, and those with HbA1c-NOIT had a longer duration of diabetes than those with HbA1c-OIT (median, 13 vs 8 years).…”

“…However, a recent meta‐analysis demonstrated that HbA1c target achievement is low, with a pooled average of 43% worldwide,3 both in primary and secondary care settings. The reason for this low target achievement, despite the expanding arsenal of glucose‐lowering interventions, remains to be elucidated.…”

Improved treatment satisfaction in patients with type 2 diabetes treated with once‐weekly semaglutide in the SUSTAIN trials

“…glucagon-like peptide-1 analogue, hypoglycaemia, incretin therapy, type 2 diabetes, weight control 1 | INTRODUCTION Despite the availability of effective glucose-lowering agents, many patients with type 2 diabetes (T2D) do not achieve glycaemic targets. [1][2][3] Adherence to and persistence with treatment regimens are important factors for treatment effectiveness. 4 Higher treatment satisfaction has been associated with better treatment adherence and improved persistence.…”

Type 2 diabetes treatment and outcomes worldwide: A short review of the DISCOVER study programme

“…2 Despite treatment advances in the past two decades, the available evidence suggests that the attainment of adequate glycaemic control, and the management of additional risk factors for T2D-related complications, remains suboptimal in a substantial proportion of people with T2D worldwide. [4][5][6] Moreover, global healthcare expenditure on T2D-related complications, such as cardiovascular and renal disease, is high and increasing. 2 These findings suggest that the current strategies for disease management are insufficient.…”