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Observational Study
. 2018 Feb;20(2):389-399.
doi: 10.1111/dom.13083. Epub 2017 Sep 28.

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

Kamlesh Khunti  1 , Thomas R Godec  2 , Jesús Medina  3 , Laura Garcia-Alvarez  4 , Josh Hiller  5 , Marilia B Gomes  6 , Javier Cid-Ruzafa  7 , Bernard Charbonnel  8 , Peter Fenici  9 , Niklas Hammar  10   11 , Kiyoshi Hashigami  12 , Mikhail Kosiborod  13   14 , Antonio Nicolucci  15 , Marina V Shestakova  16   17 , Linong Ji  18 , Stuart Pocock  2
Affiliations
Observational Study

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

Kamlesh Khunti et al. Diabetes Obes Metab. 2018 Feb.

Abstract

Aim: To 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 methods: This 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.

Results: Patients 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]).

Conclusions: Many 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.

Keywords: glycaemic control; observational study; primary care; type 2 diabetes.

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Conflict of interest statement

K. K., J. M., M. B. G., J. C.‐R., B. C., P. F., N. H., K. H., M. K., A. N., M. V. S., L. J. and S. P. were or are members of the DISCOVER Scientific Committee. J. M., P. F., N. H. and K. H. are employees of AstraZeneca. L. G.‐A. and J. H. are employees of QuintilesIMS Health and provide consulting services. J. C.‐R. is an employee of Evidera. In addition, K. K. has received honoraria and research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche and Sanofi, and acknowledges support from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care – East Midlands (CLAHRC – EM), and the NIHR Leicester‐Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester. M. B. G. previously received honoraria from Merck Serono. B. C. has received honoraria from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharpe & Dohme, Novartis, Novo Nordisk, Sanofi and Takeda; M. K. has received honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Glytec Systems, Merck (Diabetes), Novo Nordisk, Sanofi, Janssen, Eisai and ZS Pharma, and research support from AstraZeneca and Boehringer Ingelheim. A. N. has received honoraria from AstraZeneca, Eli Lilly, Medtronic and Novo Nordisk, and research support from Artsana, Dexcom, Novo Nordisk and Sanofi‐Aventis. M. V. S. has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk and Sanofi, and research support from Sanofi. L. J. has received honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Eli Lilly, Merck, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Sanofi and Takeda, and research support from AstraZeneca, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Roche and Sanofi. S. P. has received honoraria from AstraZeneca. T. R. G. has no disclosures.

Figures

Figure 1
Figure 1
Association between 6‐month change in HbA1c and baseline HbA1c. HbA1c, glycated haemoglobin
See this image and copyright information in PMC

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