Outcomes and Treatment Patterns of Adding a Third Agent to 2 OADs in Patients with Type 2 Diabetes

Levin, Philip; Wei, Wenhui; Zhou, Steve; Xie, Lin; Başer, Onur

doi:10.18553/jmcp.2014.20.5.501

Cited by 31 publications

(51 citation statements)

References 22 publications

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“…Moreover, mean glycaemic values were lower among subjects intensified by the addition of a new NIAD than by adding insulin. Our results support previous studies reporting that, in patients taking ≥2 OADs, the addition of a further oral medication takes place when HbA1c values are between 8.4% and 9.1%, and therapy is stepped up with insulin at when HbA1c values are between 9.2% and 9.9% . This reflects extremely poor glycaemic control, far above the recommended targets advocated in local and international guidelines.…”

Section: Discussionsupporting

confidence: 88%

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

Mata-Cases

Franch-Nadal

Real

et al. 2017

Diabetes Obesity Metabolism

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Section: Discussionsupporting

confidence: 88%

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

Mata-Cases

Franch-Nadal

Real

et al. 2017

Diabetes Obesity Metabolism

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“…Pharmacotherapy intensification is generally recommended when glycaemic level is inadequately controlled despite acceptable medication adherence . Supporting the clinical guidelines, observational studies have consistently shown a positive association between the decrease in HbA1c and treatment intensification in patients who did not achieve glycaemic control with metformin (MET)‐based antidiabetic care . Time in clinical inertia, that is, the failure to initiate or intensify treatment when indicated, needs to be shortened to increase the likelihood of attaining glycaemic control and lower HbA1c levels .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Kim

Unni

Brixner

et al. 2019

Diabetes Obesity Metabolism

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Aims To identify change in glycated haemoglobin (HbA1c) for 1 year after treatment intensification in patients with HbA1c >53 mmol/mol (7.0%) while on two classes of oral antidiabetic drugs (OADs). Material and methods A retrospective cohort study was conducted using a regional health plan claims database for the period January 1, 2010 to March 31, 2017. Patients with type 2 diabetes (T2DM) whose treatment was intensified with insulin, a glucagon‐like peptide‐1 receptor agonist or a third OAD within 365 days of having HbA1c ≥53 mmol/mol (7.0%) on two OADs were included. The HbA1c trajectory for 1 year after intensification was estimated using a mixed‐effects regression model. Results The analysis included 1226 patients with a mean ± SD HbA1c at treatment intensification of 74.2 ± 18.7 mmol/mol (8.93 ± 1.7%). HbA1c was higher in the insulin group (74.2 mmol/mol) than in the non‐insulin group (70.6 mmol/mol), as was the HbA1c decrease ( P < 0.01) over the 1‐year follow‐up, particularly in patients with baseline HbA1c >9%. After intensification, insulin‐ and non‐insulin‐treated patients achieved an average change by month in HbA1c of −4.7 mmol/mol and −2.6 mmol/mol points, respectively. The analysis predicted HbA1c to be the lowest at 6 to 10 months post intensification, depending on intensification treatment and HbA1c at intensification; however, on average, HbA1c remained above 64.0 mmol/mol (8.0%). Conclusion In patients with T2DM, intensification following an HbA1c value ≥53 mmol/mol (7.0%) while on two OADs was associated with a significant improvement in glycaemic control. Patients intensified with insulin had a higher baseline HbA1c but greater HbA1c reduction than those intensified with a non‐insulin agent. However, HbA1c remained above 64 mmol/mol (8.0%) overall. Additional opportunity exists to further intensify therapy to improve glycaemic control.

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“…Almost 40% of patients in whom a GLP-1 receptor agonist was added switched therapy during the first year, compared with 25% of patients in whom insulin was added and 9% of those in whom a third OAD was added. However, the greater treatment persistence among patients with triple-OAD therapy did not translate into better glycemic control [36].…”

Section: Discussionmentioning

confidence: 93%

Type 2 diabetes mellitus treatment patterns in US nursing home residents

Zarowitz¹,

Allen²,

O’Shea³

et al. 2015

Postgraduate Medicine

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Background. The prevalence of type 2 diabetes mellitus (diabetes) in nursing home residents (NHRs) is increasing, concurrently with obesity and other comorbid conditions. NHR would benefit greatly from antidiabetic medications that would improve glycemic control and give a lower risk of hypoglycemia but that do not contribute to weight gain in obese individuals. Objective. To examine the prescription patterns to NHRs with diabetes, including the use of newer injectable therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. Methods. Treatment patterns of diabetes in NHR were analyzed using Minimum Data Set records and prescription claims from the Omnicare Senior Health Outcomes data repository (May 2011-September 2012). Results. The prevalence of diabetes in this population of 229,283 NHRs was 35.4%. Among the 44,665 NHRs with diabetes and prescription claims data, the prevalence of obesity (40.3%) and multiple comorbidities (100%) was high. Approximately 20% of the NHRs with diabetes were aged <65 years. Overall, 20% of NHRs had diabetes that was untreated with medications during the study period. Insulin was the mainstay of treatment (>80%), followed by oral agents (54%). GLP-1 receptor agonist use was low (0.5%) and associated with poor treatment persistence. Conclusion. Considerations other than glycemic control may drive prescribing decisions, contrary to recommendations

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Outcomes and Treatment Patterns of Adding a Third Agent to 2 OADs in Patients with Type 2 Diabetes

Cited by 31 publications

References 22 publications

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Type 2 diabetes mellitus treatment patterns in US nursing home residents

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