What are the factors associated with long‐term glycaemic control in patients with type 2 diabetes and elevated glycated haemoglobin (≥7.0%) at initiation of second‐line therapy? Results from the DISCOVER study

Abstract

Aims Glycaemic control is a cornerstone of type 2 diabetes (T2D) management. We assessed factors associated with good long‐term glycaemic control in patients with glycated haemoglobin (HbA1c) ≥7.0% at initiation of second‐line glucose‐lowering therapy, using data from DISCOVER, a global, prospective, 3‐year observational study of patients with T2D. Materials and Methods This analysis included patients with HbA1c ≥7.0% at baseline (initiation of second‐line therapy). Multivariable regression models assessed factors associated with having HbA1c <7.0% at 3 years in two distinct groups: patients with (a) HbA1c ≥7.0% and <9.0%, and (b) HbA1c ≥9.0% at baseline. Results In total, 7575 patients with baseline HbA1c ≥7.0% were included (2233 with baseline HbA1c ≥9.0%). At 6 months, 43.7% and 24.2% of patients had an HbA1c level <7.0% in groups a and b, respectively; the corresponding proportions at 3 years were 45.8% and 29.3%. Having HbA1c <7.0% at 6 months (vs. ≥7.0%) was the strongest predictor of having HbA1c <7.0% at 3 years in both group a and group b [odds ratio (95% confidence interval): 2.01 (1.77‐2.27) and 2.68 (2.10‐3.41), respectively]. Longer T2D duration was associated with a decreased likelihood of having HbA1c <7.0% at 3 years. Conclusions In patients with poor glycaemic control at initiation of second‐line therapy, early attainment of HbA1c <7.0% appears predictive of long‐term glycaemic control, suggesting that timely modification of treatment strategies in patients with elevated HbA1c after 6 months is important to minimize therapeutic inertia.

Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come?

“…Early clinical inertia and delays in achieving a desired level of glycaemic control have been associated with increased probability of the patient failing to achieve their glycaemic targets later in the disease process 69,73 . The opposite has also been reported—treatment modification in patients with elevated HbA1c after 6 months reduced therapeutic inertia and was predictive of better long‐term glycaemic control 74 …”

“…69,73 The opposite has also been reported-treatment modification in patients with elevated HbA1c after 6 months reduced therapeutic inertia and was predictive of better long-term glycaemic control. 74 Clinical inertia is also a barrier to effective weight management.…”

The Effectiveness of an eHealth Family-Based Intervention Program in Patients With Uncontrolled Type 2 Diabetes Mellitus (T2DM) in the Community Via WeChat: Randomized Controlled Trial

“…Glycated hemoglobin (HbA 1c ) can be used to determine glucose control level [ 6 ]. HbA 1c ≥7% indicates that a patient has poor glucose control [ 7 ].…”

Glucose‐lowering drug use in migrants and native Danes with type 2 diabetes: Disparities in combination therapy and drug types

“…In type 2 diabetes (T2D), glucose‐lowering drugs (GLDs) are a critical part of clinical care, as hyperglycaemia is an important risk factor for complications. Combination therapy (prescription of more than one GLD) is a way to intensify treatment and improve glycaemic control 1–3 . Hyperglycaemia is more prevalent in migrants with T2D compared to native populations, 4–8 despite GLD treatment being prescribed earlier and to a larger proportion of migrants 6,8 .…”

“…Combination therapy (prescription of more than one GLD) is a way to intensify treatment and improve glycaemic control. [1][2][3] Hyperglycaemia is more prevalent in migrants with T2D compared to native populations, [4][5][6][7][8] despite GLD treatment being prescribed earlier and to a larger proportion of migrants. 6,8 No study has examined combination therapy in migrants, but indirect evidence suggests that disparities are likely, as non-White minorities in the United Kingdom were slower and less likely to intensify to combination therapy than White groups, 9 and migrants in Italy with T2D purchased fewer packages of noninsulin GLDs per person-year than their native counterparts.…”