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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.

Author information

1
Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia. Electronic address: maja.cigrovskiberkovic@gmail.com.
2
Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia.
3
Department for Internal Medicine, General Hospital Čakovec, Čakovec, Croatia.
4
Faculty of Medicine, J.J. Strossmayer University Osijek, Clinical Hospital Center Osijek, J. Huttlera 4, 31000 Osijek, Croatia.

Abstract

AIM:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

KEYWORDS:

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

PMID:
28314484
DOI:
10.1016/j.pcd.2017.02.004
[Indexed for MEDLINE]

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