Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007–2013 in Catalonia: a population-based study

Abstract

ObjectivesTo assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM).DesignCross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database.SettingPrimary healthcare centres, including the entire population attended by the Institut Català de la Salut in Catalonia, Spain, from 2007 to 2013.ParticipantsPatients aged 31–90 years with a diagnosis of T2DM.ResultsThe number of registered patients with T2DM in the database was 257 072 in 2007, increasing up to 343 969 in 2013. The proportion of patients not pharmacologically treated decreased by 9.7% (95% CI −9.48% to −9.92%), while there was an increase in the percentage of patients on monotherapy (4.4% increase; 95% CI 4.16% to 4.64%), combination therapy (2.8% increase; 95% CI 2.58% to 3.02%), and insulin alone or in combination (increasing 2.5%; 95% CI 2.2% to 2.8%). The use of metformin and dipeptidyl peptidase-IV inhibitors increased gradually, while sulfonylureas, glitazones and α-glucosidase inhibitors decreased. The use of glinides remained stable, and the use of glucagon-like peptide-1 receptor agonists was still marginal. Regarding glycaemic control, there were no relevant differences across years: mean glycated haemoglobin (HbA1c) value was around 7.2%; the percentage of patients reaching an HbA1c≤7% target ranged between 52.2% and 55.6%; and those attaining their individualised target from 72.8% to 75.7%.ConclusionsAlthough the proportion of patients under pharmacological treatment increased substantially over time and there was an increase in the use of combination therapies, there have not been relevant changes in glycaemic control during the 2007–2013 period in Catalonia.

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

“…In the particular case of type 2 diabetes (T2DM), clinical guidelines for management recommend early and continued adequate glucose control in order to avoid prolonged exposure to hyperglycaemia, which is associated with micro‐ and macrovascular complications . Nevertheless, over half of patients fail to achieve therapeutic target glycaemic control even with therapy at maximal doses, therefore requiring addition of oral or injectable therapies . The glycated hemoglobin (HbA1c) value at which treatment intensification is recommended varies between 6.5% and 8.0% in international, national and local guidelines, and it is 8% for incentivization purposes in our institution (Catalan Institute of Health; ICS) .…”

“…[3][4][5][6] Nevertheless, over half of patients fail to achieve therapeutic target glycaemic control even with therapy at maximal doses, therefore requiring addition of oral or injectable therapies. [7][8][9] The glycated hemoglobin (HbA1c) value at which treatment intensification is recommended varies between 6.5% and 8.0% in international, 6,10-12 national 13 and local 14 guidelines, and it is 8% for incentivization purposes in our institution (Catalan Institute of Health; ICS). 15 However, some advocate for an individualized approach, with stringent HbA1c goals (6.0%-6.5%) in selected healthy subjects and a relaxed goal (7.5%-8%) in those with health complications and those without sufficient empowerment, resources or social support.…”

Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

“…However, only 32 and 68% of Spanish patients are reaching HbA1c levels of <6.5% (47.5 mmol/mol) and <7.5% (58.5 mmol/mol), respectively, and only 55% of patients are adequately controlled with respect to individualized glycemic targets [12]. In Catalonia, between 2007 and 2013 the percentages of patients who reached an HbA1c value of ≤7% (53 mmol/mol) ranged between 52 and 56% but did not notably increase over time [13]. …”

Drug-class-specific changes in the volume and cost of antidiabetic medications in Poland between 2012 and 2015

“…The market share of long-acting, fast-acting and biphasic analogues was respectively 52%, 27% and 8% in the US in 2012 [23] and 26.3%, 27.1% and 22.7% in the UK in 2008 [13]. At the same time the share of human NPH insulin decreased to 4% in the US and 5.6% in the UK.…”