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Diabet Med. 2019 Jan 17. doi: 10.1111/dme.13900. [Epub ahead of print]

Intensification patterns and the probability of HbA1c goal attainment in Type 2 diabetes mellitus: real-world evidence for the concept of 'intensification inertia'.

Author information

1
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA.
2
Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
3
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
4
Chief Medical Officer, Novo Nordisk Inc., Plainsboro, NJ, USA.
5
Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ, USA.
6
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

AIMS:

To assess the effects of 'clinical' and 'intensification inertia' by evaluating the impact of different intensification interventions on the probability of HbA1c goal attainment using real-world data.

METHODS:

Electronic health records (Cleveland Clinic, 2005-2016) were used to identify 7389 people with Type 2 diabetes mellitus and HbA1c ≥53 mmol/mol (≥7.0%), despite a stable regimen of two oral antihyperglycaemic drugs for ≥6 months. The participants were stratified by index HbA1c and analysed over a 6-month period for pharmacological intensification, and then for 12 additional months for HbA1c goal attainment (<53 mmol/mol).

RESULTS:

The probability of HbA1c goal attainment (Kaplan-Meier analysis) in the group with index HbA1c 53-63 mmol/mol (7.0-7.9%) was highest with the addition of oral antidiabetic drugs [57.3% (95% CI 52.1, 62.0)] or glucagon-like peptide-1 receptor agonists [56.7% (95% CI 40.4, 68.6)], in the 64-74 mmol/mol (8.0-8.9%) group with the addition of oral antidiabetic drugs [31.9% (95% CI 25.1, 38.1)] or insulin [30.6% (95% CI 18.3, 41.0)], and in the ≥75 mmol/mol (≥9.0%) group with the addition of glucagon-like peptide-1 receptor agonists [53.0% (95% CI 31.8, 67.6)] or insulin [43.5% (95% CI 36.4, 49.8)].

CONCLUSIONS:

Numerical, but not statistically significant, differences in HbA1c goal attainment probability by type of intensification were most marked in people with the highest index HbA1c [≥75 mmol/mol (≥9.0%)]; in this group, injectable therapy showed trends toward greater glycaemic control benefits. Additional research into the phenomenon of intensification inertia is warranted.

PMID:
30653705
DOI:
10.1111/dme.13900

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