Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

Puente, Joan Barrot-de la; Mata-Cases, Manel; Franch‐Nadal, Josep; Mundet-Tudurí, Xavier; Casellas, Aina; Fernández‐Real, José‐Manuel; Mauricio, Dı́dac

doi:10.1111/ijcp.12741

Cited by 55 publications

(43 citation statements)

References 26 publications

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“…In this group, HDL-c levels were lower than those of individuals with glycaemia under 100 mg/dL. Both groups presented BMI above normal values supporting the connection between obesity, DM and CVD as showed by other authors [17] [18]. Alterations in the lipid profile of DM patients are common in the literature, although with inconsistent findings when comparing the different fractions and components.…”

Section: Discussionsupporting

confidence: 77%

Association between Hyperglycemia, C-Reactive Protein and Other Risk Factors in Patients at Cardiovascular Risk

Barbalho¹,

Toffano²,

Bechara³

et al. 2016

JDM

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Type 2 diabetes (DM2) is a syndrome characterized by postprandial hyperglycemia normally due to peripheral resistance to insulin and accounts for approximately 90% of diabetes cases worldwide and it is usually related to dyslipidemia, overweight/obesity and physical inactivity and increase in the risk of cardiovascular disease. This study aimed to compare the metabolic and inflammatory profile of hyperglycemic with non-hyperglycemic subjects in a group of patients undergoing coronary arteriography. Our group of patients showed that 63.16% presented glycaemia above 99 mg/dL (from the hyperglycemic patients, 31 individuals were classified as glucose intolerant and 29 as diabetic). Significant differences were found for glycaemia, LDL-c (Low Density Lipoprotein), and hs-CRP (high sensitivity C reactive protein) levels. Nevertheless it is possible to observe that patients with higher glycaemia showed increased values of Total Cholesterol, Triglycerides, LDL-c, Castelli Index I and II and estimative of LDL-c size particle and decreased HDL-c (High Density Lipoprotein) values. The comparison between hs-CRP levels and biochemical parameters shows significant differences for Body Mass Index, Triglycerides, HDL-c and the estimative of LDL-c particle. Also, the presence of Metabolic Syndrome is more prevalent in patients with high levels of hs-CRP. Diabetes patients have more significant increase in morbidity and mortality than the general population frequently due to further complications associated with the resistance to insulin. It is indispensable to outline the anthropometric and biochemical profile from hyperglycemic patients in order to work on secondary prevention of cardiovascular disease.

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Section: Discussionsupporting

confidence: 77%

Association between Hyperglycemia, C-Reactive Protein and Other Risk Factors in Patients at Cardiovascular Risk

Barbalho¹,

Toffano²,

Bechara³

et al. 2016

JDM

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“…A great number of treatment options show notable efficacy in RCTs, but their impact on glycaemic control in real-world clinical practice is usually less than expected. 27 Our results 23,24 Our results also suggest that the best glycaemic control is achieved in the elderly and in patients with comorbid conditions, whereas the worst control was observed among women.…”

Section: Discussionsupporting

confidence: 60%

Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting

Canivell

Mata-Cases

Real

et al. 2019

Diabetes Obesity Metabolism

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Aim: To assess glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on ≥2 non-insulin antidiabetic drugs (NIADS).Methods: A retrospective cohort study, using electronic health records from the SIDIAP database (2010-2014), was conducted. Intensification was defined as the prescription of any new antidiabetic drug in patients treated with ≥2 NIADS and HbA1c >7%. The primary outcome was the absolute change in HbA1c 6-12 months after any intensification. Secondary analyses included the percentage of patients reaching HbA1c <7%, HbA1c <8%, and a reduction of HbA1c >1% after the first intensification.Results: There were 21 241 intensifications in 15 205 patients with a mean (SD) HbA1c of 9.02% (±1.35). Insulin and dipeptidyl peptidase-4 inhibitors (DPP4i) were the most frequently added therapies. The mean baseline-adjusted HbA1c reduction was 0.78% (95% CI, −0.80 to −0.76), varying from −0.69% with DPP4i to −0.85% with glucagon-like peptide-1 receptor agonists while the addition of insulin was associated with a reduction >1%.After the first intensification, 48.9% of patients achieved HbA1c <8%, 16.2% HbA1c <7%, and 43.1% a reduction >1%. High previous HbA1c was positively associated with the reduction of HbA1c >1% [odds ratio (OR) 2.13 (95% CI: 2.05-2.21)], but inversely associated with the attainment of HbA1c <7% [OR 0.64 (0.61-0.67)] or < 8% [OR 0.63 (0.60-0.65)]. Older age, male gender, higher Charlson index, and short diabetes duration were associated with achievement of HbA1c <7%.Conclusions: Despite intensification, most patients failed the glycaemic goal of HbA1c <7%. The reduction depended mainly on preintensification HbA1c values, with small differences between drugs. K E Y W O R D Sglycaemic control, intensification, observational, type 2 diabetes mellitus *Both authors contributed equally to this work.

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“…The earlier study on trajectories also reported that poor responders were represented by a relatively younger population . These findings are supported by other studies showing that patients at younger ages have poorer glycaemic control . One of the causes for this could be that younger patients may have a more irregular lifestyle and consequently more problems in adhering to treatment with insulin .…”

Section: Discussionsupporting

confidence: 54%

HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups

Sidorenkov

Boven

Hoekstra

et al. 2018

Diabetes Obesity Metabolism

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AimsTo identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics.Materials and methodsA cohort study was conducted in patients with T2DM initiating insulin in 2007–2013 with a follow‐up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one‐way ANOVA, Kruskal‐Wallis or chi‐square tests, where appropriate.ResultsFrom 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6–7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well‐controlled for HbA1c, systolic blood pressure and LDL‐cholesterol at insulin initiation.ConclusionsMost patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk‐factor controls at the time of insulin initiation.

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Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

Cited by 55 publications

References 26 publications

Association between Hyperglycemia, C-Reactive Protein and Other Risk Factors in Patients at Cardiovascular Risk

Association between Hyperglycemia, C-Reactive Protein and Other Risk Factors in Patients at Cardiovascular Risk

Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting

HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups

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