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Prim Care Diabetes. 2017 Jun;11(3):265-272. doi: 10.1016/j.pcd.2017.02.004. Epub 2017 Mar 15.

Impact of health policy and practice on finding the best fit for patients with type 2 diabetes after metformin failure: Croatian pilot study.

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Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia. Electronic address:
Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia.
Department for Internal Medicine, General Hospital Čakovec, Čakovec, Croatia.
Faculty of Medicine, J.J. Strossmayer University Osijek, Clinical Hospital Center Osijek, J. Huttlera 4, 31000 Osijek, Croatia.



We assessed the impact of clinical practice and health policy on the choice and efficacy of different second-line therapies for the treatment of type 2 diabetes (T2DM) after failure of metformin.


This retrospective database analysis included 200 patients with a follow-up period of 6 months. The primary end-point was achievement of HbA1c <7% and fasting (FBG) and postprandial glucose levels (PPG) <7.2mmol/L and <10mmol/L, respectively after three and six months of different add-on treatments. Secondary end-points were weight change during treatment and incidence of hypoglycemia.


All second-line therapeutic options, except human basal insulin (BHI) and thiazolidendions (TZD) significantly increased the proportion of patients reaching target HbA1c after 6 months (p<0.01). Only sulfonylurea (SU) and dipeptidyl peptidase-4 (DPP-4) inhibitors significantly reduced all monitored parameters of glucoregulation without changing body weight and BMI after 3 and 6 months as opposed to insulin agents. However, there were no statistically significant differences between the groups when adjusting for starting HbA1c, FBG and PPG (F=1.16, p=NS), although a statistically significant difference in HbA1c levels (F=3.35, p<0.01) persisted in DPP-4 inhibitor users. The incidence of hypoglycemia was significantly higher in patients treated with NPH insulin and premixed insulin than in patients treated with other agents.


A more aggressive approach is needed with early treatment intensification using available agents.


Croatian setting; Diabetes mellitus type 2; HbA1c; Metformin failure; Oral hypoglycemic agents

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