Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain

Abstract

BackgroundInformation about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control.MethodsCross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed.ResultsA total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41–42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56–68 %.ConclusionsIndividualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.

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

“…In line with other guidelines, Spanish treatment guidelines recommend glycated hemoglobin (HbA1c) target levels of <6.5% (47.5 mmol/mol) if patients are newly diagnosed with type 2 diabetes, younger than 70 years and without diabetes-related complications, and <7.5% (58.5 mmol/mol) otherwise [11]. 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].…”

Metabolic Control of GP-led Hypertensive Type 2 Diabetes Patients on Oral Antidiabetic Drugs

“…Our data should be reviewed in the light of previous publications coming from international and national studies although bearing in mind that patients were not similar in terms of age, duration of diabetes, medications used etc. In a cross-sectional analysis on 5382 type 2 diabetic patients in the primary care setting in Spain between 2011 and 2012, 17.1 and 67% applied to ADA/EASD recommendation of HbA1c target of <7 and <8% [20]. A Chinese study examined the data of 9065 adult T2DM outpatients (5035 men) between 2010 and 2012 and found glycemic control rate in only 32.6%, with the triple control rate for glycemia, blood pressure, and lipidemia -in only 11.2% [21].…”

Treatment persistence behaviours in patients with type 2 diabetes (T2DM) after initiation of basal insulin: An exploratory analysis from a Spanish real-world sample

“…Only 32% of Spanish patients reach that target level. The less stringent level of <7.5% is reached by 68% [4].…”