Evaluating glycaemic control in patients poorly controlled on oral antidiabetic drugs in real-world setting: Results from assessing the Appropriate Timing of Type 2 diAbetes INtensification (ATTAIN)

Abstract

Introduction: Many patients with type 2 diabetes mellitus (DM) fail to achieve glycaemic control despite recommended treatment strategies to reduce glycated haemoglobin (HbA1c). This real-world retrospective cohort study compared HbA1c change and treatment patterns between those intensifying and not intensifying therapy with oral antidiabetic drugs (OADs).

Materials and methods: Patients suboptimally controlled on OADs (>58 mmol/mol [>7.5%] or >64 mmol/mol [>8.0%] for high risk, index 1) were included from IQVIA Medical Research Data. Intensifiers within 12 months of index 1 were matched (1:1) to nonintensifiers. Primary outcomes were HbA1c change and proportion of participants achieving HbA1c targets 6 and 12 months post-index 2 (date of intensification [intensifiers] or pseudodate [nonintensifiers]). Therapy adherence was also assessed.

Results: A total of 10 832 participants (5539 intensifiers and 5293 nonintensifiers) were included. Mean HbA1c decrease from baseline to 6 months was -1.13% (intensifiers) vs -0.75% (nonintensifiers), with no substantial further change at 12 months. Cox proportional hazards (PH) analysis suggested a nearly 20% greater chance of target achievement at 6 months for intensifiers vs nonintensifiers (hazard ratio [HR]: 0.79 [95% confidence interval [CI]: 0.73-0.86]), which was similar at 12 months (HR: 0.80 [95% CI: 0.74-0.86]). Intensifiers tended towards greater adherence to baseline therapy (90% [standard deviation (SD): 14.9] vs nonintensifiers 87% [SD: 16.0]), which decreased following intensification.

Conclusions: Significant reductions in HbA1c were evident at 6 months and were greater in intensifiers vs nonintensifiers. Little additional clinical benefit was seen 12 months postintensification. Despite good treatment adherence, many participants failed to achieve target HbA1c; actions beyond improved adherence are needed to improve suboptimal HbA1c.

Keywords: adherence; electronic medical records; glycaemic control; oral antidiabetic drugs; real‐world study; treatment intensification; type 2 diabetes melitus.

Figure 1

A, Change in HbA1c over time for intensifiers vs nonintensifiers. B, Change in HbA1c over time according to specific regimen subgroup. BI, basal insulin; GLP‐1 RA, glucagon‐like peptide‐1 receptor agonist; HbA1c, glycated haemoglobin; OAD, oral antidiabetic drug

Figure 2

A, Kaplan‐Meier plot for time‐to‐target achievement within 6 mo* of intensification. B, Kaplan‐Meier plot for time‐to‐target achievement within 12 mo* of intensification. *Including a 3‐month window to allow for the real‐world nature of the data. It should be noted that the crossing of the curves at approximately 3 mo is an artefact of the data due to intensifiers being ‘anchored’ by the intensification event, meaning they are unlikely to be retested within the next 3 mo (ie the earliest point that a change is likely to be seen is at 3 mo when they are retested). Nonintensifiers are assigned a ‘pseudo’ date with no anchoring event, which means they may be tested sooner than 3 mo. Consequently, some nonintensifiers seemingly improve faster, but following 3 mo of intensifiers, consistently do better. OAD, oral antidiabetic drug