Intensification patterns and the probability of HbA(1c) goal attainment in Type 2 diabetes mellitus: real-world evidence for the concept of ‘intensification inertia’.
Autor: Pantalone, K. M.; Misra-Hebert, A. D.; Hobbs, T. M.; Ji, X.; Kong, S. X.; Milinovich, A.; Weng, W.; Bauman, J. M.; Ganguly, R.; Burguera, B.; Kattan, M. W.; Zimmerman, R. S.
Publication year: 2020
Diabetic medicine : a journal of the British Diabetic Association
issn:1464-5491 0742-3071
doi: 10.1111/dme.13900
Abstract:
AIMS: To assess the effects of ‘clinical’ and ‘intensification inertia’ by evaluating the impact of different intensification interventions on the probability of HbA(1c) 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 HbA(1c) ≥53 mmol/mol (≥7.0%), despite a stable regimen of two oral antihyperglycaemic drugs for ≥6 months. The participants were stratified by index HbA(1c) and analysed over a 6-month period for pharmacological intensification, and then for 12 additional months for HbA(1c) goal attainment (<53 mmol/mol). RESULTS: The probability of HbA(1c) goal attainment (Kaplan-Meier analysis) in the group with index HbA(1c) 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 HbA(1c) goal attainment probability by type of intensification were most marked in people with the highest index HbA(1c) [≥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. Language: eng Rights: © 2019 Diabetes UK. Pmid: 30653705 Tags: Humans; Aged; Female; Male; Middle Aged; Treatment Outcome; Kaplan-Meier Estimate; Glycated Hemoglobin/*metabolism; Hypoglycemic Agents/*therapeutic use; Insulin/*therapeutic use; Patient Care Planning; *Glucagon-Like Peptide-1 Receptor Agonists; Diabetes Mellitus, Type 2/*drug therapy/metabolism; Glycemic Control/*methods Link: https://pubmed.ncbi.nlm.nih.gov/30653705/
