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Observational Study
. 2018 Jan 22;17(1):18.
doi: 10.1186/s12933-018-0661-8.

Individualised treatment targets in patients with type-2 diabetes and hypertension

Roland E Schmieder  1 , Diethelm Tschöpe  2 , Cornelia Koch  3 , Taoufik Ouarrak  4 , Anselm K Gitt  4   5 ; DIALOGUE study group
Collaborators, Affiliations
Observational Study

Individualised treatment targets in patients with type-2 diabetes and hypertension

Roland E Schmieder et al. Cardiovasc Diabetol. .

Abstract

Aim: Patients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice.

Methods: DIALOGUE was a prospective, observational, non-interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included. Patients were assigned a treatment target HbA1c value (≤ 6.5% [strict]; > 6.5 to ≤ 7.0% [intermediate]; > 7.0 to ≤ 7.5% [lenient]).

Results: 8568 patients with T2DM and hypertension were enrolled. 6691 (78.1%) had 12-month follow-up. Patients who were assigned a strict HbA1c treatment target (n = 2644) were younger, had shorter diabetes duration, and less comorbidity in comparison to those with intermediate (n = 2912) or lenient targets (n = 1135). Only 53.1% of patients achieved their HbA1c treatment target (46.2% [strict], 56.8% [intermediate], 59.4% [lenient]). There was little sign of treatment intensification for patients that had not achieved their HbA1c target.

Conclusions: Achievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels. The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with T2DM.

Keywords: Diabetes; Glucose; HbA1c; Hyperglycaemia; Hypertension; Individualised; Target.

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Figures

Fig. 1
Fig. 1
Patient flow. T2DM type-2 diabetes, FU follow-up
Fig. 2
Fig. 2
a Proportions of patients meeting treatment targets at 12 months, stratified by baseline HbA1c tertile and target type. b Change in HbA1c at 12-month follow-up by baseline HbA1c and treatment target group. Only patients with valid baseline and 12 month follow-ups including complete information on HbA1c levels were included. Percentages refer to the proportion of patients within the specific subgroup represented by each column
Fig. 3
Fig. 3
HbA1c reduction by treatment target (Baseline, 6 and 12 months). a Patients with HbA1c target ≤6.5%. b Patients with HbA1c target > 6.5 to ≤7.0%. c Patients with HbA1c target > 7.0 to ≤7.5%.  Data presented as median, 25th and 75th percentiles, maximum, and minimum values
See this image and copyright information in PMC

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