Patients with type 2 diabetes experience delays in treatment intensification, often leading to periods of suboptimal glycaemic control, conclude UK researchers.
The retrospective cohort study followed 81,573 patients with type 2 diabetes over a period of two years, with a follow-up of five years. There were three oral antidiabetic drug (OAD) regimens. In each of the three respective regimens, 50,476 patients taking one OAD, 25,600 patients taking two OADs, and 5,677 people taking three OADs were analysed. The primary end point was time to intensification from the time of being in poor control (defined as HbA1c ≥7.0%, ≥7.5%, and ≥8.0%) within each OAD regimen until return to below HbA1c target, end of current OAD regimen, or end of follow-up data. Treatment intensification was defined as either addition of further OAD prescription without change in current OAD prescription or initiation of insulin irrespective of changes in OAD regimen. The current NICE recommended target HbA1c is 6.5%.
In patients with HbA1c ≥7.0%, ≥7.5%, or ≥8.0% the median time from above the HbA1c cut-off to intensification with an additional OAD was 2.9, 1.9 or 1.6 years respectively, and >7.2, >7.2 and >6.9 years for those taking two OADs. The median time to intensification with insulin was >7.1, >6.1, or >6.0 years for those taking one, two, or three OADs. The mean HbA1c at intensification with an OAD or insulin for people taking one, two, or three OADs was 8.7, 9.1 and 9.7%.
What this means for GPs
The researchers note that the analysis ‘demonstrates that there is a delay in intensifying treatment in people with type 2 diabetes with suboptimal glycaemic control’ and that these patients ‘experienced prolonged periods of poor glycaemic control’. They advise that ‘a greater effort must be made to motivate people with diabetes and physicians to improve diabetes management, and that motivation needs to be translated into action by striving for the recommended treatment in a timely manner’.