Glycaemic control in patients with type 2 diabetes initiating second‐line therapy: Results from the global DISCOVER study programme

Abstract

Aim To assess glycaemic control and factors associated with poor glycaemic control at initiation of second‐line therapy in the DISCOVER programme. Materials and methods DISCOVER (NCT02322762 and NCT02226822) comprises two similar prospective observational studies of 15 992 people with type 2 diabetes (T2D) initiating second‐line glucose‐lowering therapy in 38 countries across six regions (Africa, Americas, South‐East Asia, Eastern Mediterranean, Europe and Western Pacific). Data were collected using a standardized case report form. Glycated haemoglobin (HbA1c) levels were measured according to standard clinical practice in each country, and factors associated with poor glycaemic control (HbA1c >8.0%) were evaluated using hierarchical regression models. Results HbA1c levels were available for 80.9% of patients (across‐region range [ARR] 57.5%‐97.5%); 92.2% (ARR 59.2%‐99.1%) of patients had either HbA1c or fasting plasma glucose levels available. The mean HbA1c was 8.3% (ARR 7.9%‐8.7%). In total, 26.7% of patients had an HbA1c level ≥9.0%, with the highest proportions in South‐East Asia (35.6%). Factors associated with having HbA1c >8.0% at initiation of second‐line therapy included low education level, low country income, and longer time since T2D diagnosis. Conclusions The poor levels of glycaemic control at initiation of second‐line therapy suggest that intensification of glucose‐lowering treatment is delayed in many patients with T2D. In some countries, HbA1c levels are not routinely measured. These findings highlight an urgent need for interventions to improve monitoring and management of glycaemic control worldwide, particularly in lower‐middle‐ and upper‐middle‐income countries.

Type 2 diabetes treatment and outcomes worldwide: A short review of the DISCOVER study programme

“…These findings suggest that HbA1c levels are not measured routinely in all countries, although other reasons such as a lack of recording of HbA1c data by physicians may also be responsible. 11 Patients in DISCOVER also had a high burden of vascular complications at baseline: the age-and sex-standardized prevalence of microvascular and macrovascular complications was 17.9% (ARR 14.2%-20.4%) and 9.2% (ARR 4.1%-18.8%), respectively, which is concerning given that these patients are at a relatively early disease stage (median time since diagnosis of T2D at baseline was 4.1 years). 12 Other important investigations, including measurements of estimated glomerular filtration rate, urine albumin-to-creatinine ratio and lipid variables, were carried out even less frequently than HbA1c level measurement, and the use of preventive treatments, such as statins, was lower than expected in this patient population.…”

“…In nine countries, eight of which had middle‐income economies, HbA1c levels were missing for >30% of participants. These findings suggest that HbA1c levels are not measured routinely in all countries, although other reasons such as a lack of recording of HbA1c data by physicians may also be responsible . Patients in DISCOVER also had a high burden of vascular complications at baseline: the age‐ and sex‐standardized prevalence of microvascular and macrovascular complications was 17.9% (ARR 14.2%‐20.4%) and 9.2% (ARR 4.1%‐18.8%), respectively, which is concerning given that these patients are at a relatively early disease stage (median time since diagnosis of T2D at baseline was 4.1 years) .…”

Cardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data

“…However, global outcomes data are sparse for new therapies in people with type 2 diabetes, especially outside North America and Europe. Previous studies have shown large variations in the management of people with diabetes and the prevalence of complications [ 5 , 6 ]. More recently, global collaborative studies have shown that there are differences in patient characteristics, treatment patterns, and types of adverse CVD events experienced by patients in different regions and different ethnicities [ 7 ].…”

Advances in GLP-1 treatment: focus on oral semaglutide

“…Notwithstanding the efforts to improve the treatment of T2D with the development of new drugs, the percentage of patients achieving optimal glycemic control (HbA1c < 7.0%) is still lower than desired, and mortality remains high, indicating the necessity of new therapies for T2D [ 14 ]. The global perspective DISCOVER study program demonstrated that exists a failure to monitor blood glucose in T2D patients that results in poor levels of glycemic control at initiation of second line therapy, particularly in lower-middle- and upper-middle-income countries [ 15 ]. At this stage of treatment, 26.7% of the tested patients had an HbA1c level ≥ 9.0% [ 15 ].…”

“…The global perspective DISCOVER study program demonstrated that exists a failure to monitor blood glucose in T2D patients that results in poor levels of glycemic control at initiation of second line therapy, particularly in lower-middle- and upper-middle-income countries [ 15 ]. At this stage of treatment, 26.7% of the tested patients had an HbA1c level ≥ 9.0% [ 15 ]. Lack of efficiency was the most stated reason for choosing a second-line therapy, followed by physician preference, patient request, and side effects [ 15 ].…”