Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor‐based electronic health record

Brouwer, Emily S.; West, Suzanne L.; Kluckman, Marianne; Wallace, Dennis; Masica, Andrew L.; Ewen, Edward; Kudyakov, Rustam; Cheng, Dunlei; Bowen, J. Richard; Fleming, Neil

doi:10.1002/pds.2262

Cited by 27 publications

(27 citation statements)

References 42 publications

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“…Black patients have been demonstrated to have lower rates of health literacy [57], which is a demonstrated risk factor for hypoglycemia [60]. In addition, race may impact a clinician's choice of diabetes agents and changes in regimens [61]. In the pediatric population, minority children were shown to be less likely than white children to receive diabetes management support in school [62].…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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The 2014 National Action Plan for Adverse Drug Event Prevention has recognized adverse drug events (ADEs) as a national priority in order to facilitate a nationwide reduction in patient harms from these events. Throughout this effort, it will be integral to identify populations that may be at particular risk in order to improve care for these patients. We have undertaken a systematic review to evaluate the evidence regarding racial or ethnic disparities in ADEs with particular emphasis on anticoagulants, diabetes agents, and opioids due to the clinical significance and preventability of ADEs associated with these medication classes. From an initial search yielding 3302 studies, we identified 40 eligible studies. Twenty-seven of these included studies demonstrated the presence of a racial or ethnic disparity. There was no consistent evidence for racial or ethnic disparities in the eight studies of ADEs in general. Asians were most frequently determined to be at higher risk of anticoagulant-related ADEs, and black patients were most frequently determined to be at higher risk for diabetes agents-related ADEs. Whites were most frequently identified as at increased risk for opioid-related ADEs. However, few of these studies were specifically designed to evaluate racial or ethnic disparities, lacking a standardized approach to racial/ethnic categorization as well as control for potential confounders. We suggest the need for targeted interventions to reduce ADEs in populations that may be at increased risk, and we suggest strategies for future research.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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“…Surveys of prescription patterns in primary care show that the majority of newly diagnosed patients with type 2 diabetes are treated with metformin monotherapy 9. Higher HbA1c levels are associated with increased likelihood of being prescribed combination therapy, perhaps reflecting recommendations from expert groups that initial combination therapy (rather than stepwise addition of agents) should be considered for patients unlikely to achieve control with monotherapy 1,10.…”

Section: Discussionmentioning

confidence: 99%

Initial combination of linagliptin and metformin in patients with type 2 diabetes: efficacy and safety in a randomised, double‐blind 1‐year extension study

et al. 2013

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ObjectiveTo determine the efficacy and safety of linagliptin in initial combination with metformin in patients with type 2 diabetes.MethodsThis 1-year randomised, double-blind study was an extension of a 6-month randomised controlled trial, in which adults with type 2 diabetes received one of six treatment regimens (linagliptin 2.5 mg plus metformin 500 mg bid, linagliptin 2.5 mg plus metformin mg 1000 bid, metformin 1000 mg bid, metformin 500 mg bid, linagliptin 5 mg qd or placebo). In the extension, patients in the first three treatment groups continued their regimen (non-switched group, n = 333) while the metformin 500 mg bid, linagliptin 5 mg qd and placebo groups were re-randomised to one of the three continuing regimens (switched group, n = 233).ResultsAll three non-switched groups maintained reductions in glycosylated haemoglobin (HbA1c; mean ± standard deviation reductions across the 1.5-year period: linagliptin 2.5 plus metformin 1000 bid, –1.63 ± 1.05%; linagliptin 2.5 plus metformin 500 bid, –1.32 ± 1.06%; metformin 1000 bid, –1.25 ± 0.91%) while the switched groups showed additional HbA1c reductions. During the extension, there were no clinically meaningful changes in body weight in any group. Adverse event rates were similar between groups, with most events being mild or moderate, and the incidence of investigator-defined hypoglycaemia was low, with no severe events.DiscussionInitial combination of linagliptin and metformin was well tolerated over the 1-year extension period, with low risk of hypoglycaemia, and improved glycaemic control vs. metformin alone.ConclusionThe initial combination of linagliptin and metformin appears to provide a useful treatment option in patients whose blood glucose levels are increased to an extent that metformin monotherapy may not achieve treatment targets.

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“…It has been reported that nearly one‐quarter (23%) of newly diagnosed T2DM patients in the US had an HbA1c ≥9.0% prior to initiation of treatment . For such patients, initiating insulin is difficult, although it has been almost 10 years since the ACE/AACE Diabetes Road Map suggested insulin therapy for treatment‐naïve patients with high HbA1c .…”

Section: List Of Pros and Cons Of Short‐term Intensive Insulin Theramentioning

confidence: 99%

Short‐term intensive insulin therapy could be the preferred option for new onset Type 2 diabetes mellitus patients with HbA1c > 9%

Weng

2017

Journal of Diabetes

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Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor‐based electronic health record

Abstract: Clinical and demographic characteristics influence choice and duration of initial oral hypoglycemic treatment as well as regimen changes.

Cited by 27 publications

References 42 publications

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Initial combination of linagliptin and metformin in patients with type 2 diabetes: efficacy and safety in a randomised, double‐blind 1‐year extension study

Short‐term intensive insulin therapy could be the preferred option for new onset Type 2 diabetes mellitus patients with HbA1c > 9%

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