Fabrice Bonnet1, Hungta Chen2, Andrew Cooper3, Marίlia B Gomes4, Linong Ji5, Paul Leigh3, Larisa Ramirez6, Marina V Shestakova7, Iichiro Shimomura8, Afrah Siddiqui3, Fengming Tang9, Jiten Vora10, Hirotaka Watada11, Kamlesh Khunti12. 1. Department of Endocrinology, Rennes University Hospital, Rennes 1 University, Rennes, France. 2. AstraZeneca, Gaithersburg, Maryland, USA. 3. AstraZeneca, Cambridge, UK. 4. Rio de Janeiro State University, Rio de Janeiro, Brazil. 5. Peking University People's Hospital, Beijing, China. 6. AstraZeneca, Luton, UK. 7. Endocrinology Research Center, Diabetes Institute, Moscow, Russian Federation. 8. Graduate School of Medicine, Osaka University, Osaka, Japan. 9. Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA. 10. University of Liverpool, Liverpool, UK. 11. Graduate School of Medicine, Juntendo University, Tokyo, Japan. 12. University of Leicester, Leicester, UK.
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.
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.
Authors: Matthias Blüher; Antonio Ceriello; Melanie Davies; Helena Rodbard; Naveed Sattar; Oliver Schnell; Elena Tonchevska; Francesco Giorgino Journal: Endocrinol Diabetes Metab Date: 2022-03-17