GOAL study: clinical and non-clinical predictive factors for achieving glycemic control in people with type 2 diabetes in real clinical practice

Abstract

ObjectiveThe American Diabetes Association and the European Association for the Study of Diabetes guidelines recommend to individualize treatment targets/strategies in inadequately controlled patients by lifestyle management and glucose-lowering drugs to decrease the burden of diabetes-related complications. This real-world practice study aimed to assess predictive factors for achieving the glycemic hemoglobin A1c (HbA1c) at 6 months as targeted by the treating physician in adults with type 2 diabetes who required initiation of basal insulin, initiation of bolus insulin, or modification from basal or premixed insulin to new insulin regimen containing insulin glargine and/or insulin glulisine.Research design and methodsThis was an international, multicenter, observational survey with 12-month follow-up time in adults with type 2 diabetes inadequately controlled conducted in 10 developing countries.ResultsOverall, 2704 patients (mean age: 54.6 years, body mass index: 28.7 kg/m2; Caucasian: 46.1%, type 2 diabetes duration: 10.1 years) with poor glycemic control (mean HbA1c: 9.7% (83 mmol/mol), fasting blood glucose: 196.8 mg/dL) were eligible. At 6 months, advanced age, Caucasian ethnicity, shorter type 2 diabetes duration (>10 vs 1 year, p<0.0001), lower baseline HbA1c (≥ 8.5% vs <7%, p<0.0001) and no intake of oral antidiabetic drug (OAD) (none vs 2, p=0.02) were predictive factors for achieving glycemic goal as targeted by the treating physician. Absolute changes in the mean HbA1c of −1.7% and −2% were observed from baseline to 6 and 12 months, respectively.ConclusionsAlong with some well-known predictive factors, this study suggested that early insulin regimen treatment initiation and/or intensification allowed patients to promote glycemic control.

Variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

“…We observed that younger people had worse glycaemic control than people aged >60 years. This finding has also been reported in other countries . A large observational study in Sweden showed that people with type 2 diabetes aged <55 years had the highest increase in risk of cardiovascular disease and death compared with similarly aged controls .…”

Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016

“…26 La utilización de medicamentos no se asoció con un mejor control glucémico, lo que se puede explicar por el escalamiento proporcional del tratamiento al nivel de avance de la enfermedad. 27 Sin embargo, también debe considerarse que en México se ha reportado una carencia al apego a la guía de práctica clínica y las recomendaciones de la ADA, lo que dificulta el seguimiento del paciente y su adherencia al tratamiento. 26 Hasta el momento, no se ha logrado asegurar un control glucémico adecuado en pacientes que viven con diabetes.…”

Деякі Аспекти Медикаментозної Терапії Цукрового Діабету 2-Го Типу У Людей З Надмірною Масою Тіла

“…С учетом изложенного при прочих равных условиях преимущество имеют препараты, действие которых не связано со стимуляцией бета-клеток. Осложнения СД 2-го типа связаны не только с гипергликемией, но и с дислипидемией, артериальной гипертензией, гиподинамией, курением и другими факторами, что требует индивидуального подхода [114].…”