Marilia B Gomes1, Wolfgang Rathmann2, Bernard Charbonnel3, Kamlesh Khunti4, Mikhail Kosiborod5, Antonio Nicolucci6, Stuart J Pocock7, Marina V Shestakova8, Iichiro Shimomura9, Fengming Tang10, Hirotaka Watada11, Hungta Chen12, Javier Cid-Ruzafa13, Peter Fenici14, Niklas Hammar15, Filip Surmont16, Linong Ji17. 1. Rio de Janeiro State University, Rio de Janeiro, Brazil. Electronic address: mariliabgomes@gmail.com. 2. German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. Electronic address: wolfgang.rathmann@ddz.de. 3. University of Nantes, Nantes, France. Electronic address: Bernard.Charbonnel@univ-nantes.fr. 4. University of Leicester, Leicester, UK. Electronic address: kk22@leicester.ac.uk. 5. Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri, Kansas City, MO, USA. Electronic address: mkosiborod@saint-lukes.org. 6. Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy. Electronic address: nicolucci@coresearch.it. 7. London School of Hygiene and Tropical Medicine, London, UK. Electronic address: Stuart.Pocock@lshtm.ac.uk. 8. Endocrinology Research Center, Diabetes Institute, Moscow, Russian Federation. 9. Graduate School of Medicine, Osaka University, Osaka, Japan. 10. Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. Electronic address: ftang@saint-lukes.org. 11. Graduate School of Medicine, Juntendo University, Tokyo, Japan. 12. AstraZeneca, Gaithersburg, MD, USA. Electronic address: Hungta.Chen@astrazeneca.com. 13. Evidera, Barcelona, Spain. Electronic address: Javier.Cid@evidera.com. 14. AstraZeneca, Cambridge, UK. Electronic address: Peter.Fenici@astrazeneca.com. 15. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: Niklas.Hammar@ki.se. 16. AstraZeneca, Luton, UK. Electronic address: Filip.Surmont@astrazeneca.com. 17. Peking University People's Hospital, Beijing, PR China. Electronic address: jiln@bjmu.edu.cn.
Abstract
AIMS: To describe the characteristics and treatment of patients with type 2 diabetes mellitus initiating a second-line glucose-lowering therapy in the global DISCOVER study programme. METHODS: DISCOVER comprises two similar 3-year prospective observational studies (NCT02322762 and NCT02226822), involving 15,992 patients initiating a second-line glucose-lowering therapy in 38 countries across six regions (Africa, Americas, South-East Asia, Eastern Mediterranean, Europe and Western Pacific). RESULTS: Overall, 54.2% of patients were male (across region range [ARR]: 37.7-58.6%). At baseline, mean age and time since diagnosis of type 2 diabetes mellitus were 57.2 (ARR: 53.1-61.9)and 5.6 (ARR: 4.6-6.9) years, respectively. Median glycated haemoglobin (HbA1c) was 63.9 mmol/mol (8.0%; ARR: 7.6-8.3%). Microvascular and macrovascular complications were reported in 18.9% (ARR: 14.5-23.5%) and 12.7% (ARR: 5.0-26.6%) of patients, respectively. First-line treatments were mostly metformin monotherapy (55.6%; ARR: 42.5-83.6%) and combinations of metformin with a sulfonylurea (14.4%; ARR: 5.8-31.1%). The most commonly prescribed second-line therapies were combinations of metformin with a dipeptidyl peptidase-4 inhibitor (23.5%; ARR: 2.2-29.6%) or a sulfonylurea (20.9%; ARR: 13.6-57.1%). CONCLUSIONS: DISCOVER demonstrates considerable global variation in the treatment of type 2 diabetes mellitus, and a need for more aggressive risk factor control.
AIMS: To describe the characteristics and treatment of patients with type 2 diabetes mellitus initiating a second-line glucose-lowering therapy in the global DISCOVER study programme. METHODS: DISCOVER comprises two similar 3-year prospective observational studies (NCT02322762 and NCT02226822), involving 15,992 patients initiating a second-line glucose-lowering therapy in 38 countries across six regions (Africa, Americas, South-East Asia, Eastern Mediterranean, Europe and Western Pacific). RESULTS: Overall, 54.2% of patients were male (across region range [ARR]: 37.7-58.6%). At baseline, mean age and time since diagnosis of type 2 diabetes mellitus were 57.2 (ARR: 53.1-61.9)and 5.6 (ARR: 4.6-6.9) years, respectively. Median glycated haemoglobin (HbA1c) was 63.9 mmol/mol (8.0%; ARR: 7.6-8.3%). Microvascular and macrovascular complications were reported in 18.9% (ARR: 14.5-23.5%) and 12.7% (ARR: 5.0-26.6%) of patients, respectively. First-line treatments were mostly metformin monotherapy (55.6%; ARR: 42.5-83.6%) and combinations of metformin with a sulfonylurea (14.4%; ARR: 5.8-31.1%). The most commonly prescribed second-line therapies were combinations of metformin with a dipeptidyl peptidase-4 inhibitor (23.5%; ARR: 2.2-29.6%) or a sulfonylurea (20.9%; ARR: 13.6-57.1%). CONCLUSIONS: DISCOVER demonstrates considerable global variation in the treatment of type 2 diabetes mellitus, and a need for more aggressive risk factor control.