Patterns of glycaemic control in patients with type 2 diabetes mellitus initiating second‐line therapy after metformin monotherapy: Retrospective data for 10 256 individuals from the United Kingdom and Germany

Abstract

AimTo investigate determinants of change in glycated haemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) at 6 months after initiating uninterrupted second‐line glucose‐lowering therapies.Materials and MethodsThis cohort study utilized retrospective data from 10 256 patients with T2DM who initiated second‐line glucose‐lowering therapy (switch from or add‐on to metformin) between 2011 and 2014 in Germany and the UK. Effects of pre‐specified patient characteristics on 6‐month HbA1c changes were assessed using analysis of covariance.ResultsPatients had a mean (standard error [SE]) baseline HbA1c of 8.68% (0.02); 28.5% of patients discontinued metformin and switched to an alternative therapy and the remainder initiated add‐on therapy. Mean (SE) unadjusted 6‐month HbA1c change was −1.27% (0.02). When adjusted for baseline HbA1c, 6‐month changes depended markedly on the magnitude of the baseline HbA1c (HbA1c <9%, −0.45% per unit increase in HbA1c; HbA1c ≥9%, −0.87% per unit increase in HbA1c). Adjusted mean 6‐month HbA1c reductions showed slight treatment differences (range, 0.92–1.09%; P < .001). Greater reductions in HbA1c were associated with second‐line treatment initiation within 6 months of T2DM diagnosis (1.36% vs 1.03% [P < .001]) and advanced age (≥70 years, 1.13%; <70 years, 1.02% [P < .001]).ConclusionsMany patients with T2DM have very high HbA1c levels when initiating second‐line therapy, indicating the need for earlier treatment intensification. Patient‐specific factors merit consideration when making treatment decisions.

Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: A retrospective analysis of primary care data, 2010–2017

“…Whilst the present study provides timely information on population-level trends, further observational studies, building on recent work, will be needed to establish the real-world comparative effectiveness of individual drug classes at different lines of therapy. 10,33 Our results show that prescribing of glucose-lowering therapy in Type 2 diabetes is rapidly changing towards newer, more expensive agents. Changes in prescribing appear to have pre-empted rather than reflected changes in clinical guidelines.…”

“…Although the missing records mean the absolute rates of hypoglycaemia in the present study will be an underestimate, the specificity of our key finding, a relative decrease in hypoglycaemia rates with second‐line therapy, where use of sulphonylureas has markedly declined, is reassuring. Whilst the present study provides timely information on population‐level trends, further observational studies, building on recent work, will be needed to establish the real‐world comparative effectiveness of individual drug classes at different lines of therapy …”

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

“…21,22 Indeed, adjustment for baseline Hb1c levels was crucial in order to better compare the effects of the different drugs, as already performed in these studies. 21,22 Indeed, adjustment for baseline Hb1c levels was crucial in order to better compare the effects of the different drugs, as already performed in these studies.…”

“…Regarding the achievement of HbA1c goals, we did not observe major differences between the different groups based on the glucoselowering agent after baseline adjustment, as has been observed with the addition of a second antidiabetic in other population-based studies. 21,22 Indeed, adjustment for baseline Hb1c levels was crucial in order to better compare the effects of the different drugs, as already performed in these studies. 21,22 Conversely, the achievement of the other two goals (HbA1c <7% or < 8%) was inferior with insulin and GLP-1RAs, probably because of the higher preintensification HbA1c levels in these two groups (9.4% for insulin and 9.1% for GLP-1RAs vs. 8.7-9.0%).…”

“…21,22 Indeed, adjustment for baseline Hb1c levels was crucial in order to better compare the effects of the different drugs, as already performed in these studies. 21,22 Conversely, the achievement of the other two goals (HbA1c <7% or < 8%) was inferior with insulin and GLP-1RAs, probably because of the higher preintensification HbA1c levels in these two groups (9.4% for insulin and 9.1% for GLP-1RAs vs. 8.7-9.0%). Our results are in line with those of a recent metaanalysis of 43 RCTs (overall 16 590 participants) assessing the effects of the addition of a third drug after failure of dual therapy.…”