Early Treatment Intensification and Faster Glycemic Control in T2D
Real-world evidence suggests that many patients with type 2 diabetes do not receive intensified treatment for extended periods of time despite failure to maintain glycemic control with monotherapy.
Early treatment intensification is linked with faster glycemic control—despite first-line management failure with metformin—in patients with type 2 diabetes (T2D), according to a retrospective analysis published in Diabetes Care.
The analysis included 93,515 individuals with T2D from the UK Clinical Practice Research Datalink database. Participants were aged 18 to 79, had only been treated with metformin or a sulfonylurea, and had not achieved glycemic control with these treatments.
Participants were divided into 3 groups: early intensifiers or those intensifying within 12 months, intermediate intensifiers or those intensifying between 12 to <24 months, and late intensifiers or those intensifying between 24 to <36 months.
Overall, the results indicated that 65% of individuals with T2D who intensified within 3 years after monotherapy failure attained glycemic control; 66% in the early group, 63% in the intermediate group, and 62% in the late group achieved glycemic control. In addition, individuals with T2D intensifying within 12 months of the index date had a significantly shorter median time from intensification to glycemic control; in the early group, median time from intensification to control was 20 months, 24.1 months for those in the intermediate group, and 25.7 months for those in the late group. The likelihood of attaining glycemic control was 22% and 28% lower for the intermediate and late groups, respectively, compared with the early group.
The results also showed that median durations of maintaining glycemic management, measured in months, were 16.2 for patients in the early group, 15.7 for patients in the intermediate group, and 15.9 for patients in the late group.
Earlier treatment intensification is linked with shorter time to glycemic control in individuals with T2D, the researchers concluded. They suggested that “earlier intensification may provide an opportunity not only to improve the likelihood of attaining desired [hemoglobin A1c] levels but also to sustain these levels for somewhat longer periods of time than those achieved with delayed intensification, independent of the drug used as first-line therapy.”
Funding for this study was provided by Bristol-Myers Squibb and AstraZeneca.
Disclosure: Multiple authors declare affiliations with drug companies. See reference for a complete list of disclosures.
Desai U, Kirson NY, Kim J, et al. Time to treatment intensification after monotherapy failure and its association with subsequent glycemic control among 93,515 patients with type 2 diabetes [published online August 21, 2018]. Diabetes Care. doi:10.2337/dc17-0662