Khunti Kamlesh, Wolden Michael L, Thorsted Brian Larsen, Andersen Marc, Davies Melanie J
Corresponding author: Kamlesh Khunti,
Diabetes Care. 2013 Nov;36(11):3411-7. doi: 10.2337/dc13-0331. Epub 2013 Jul 22.
To determine time to treatment intensification in people with type 2 diabetes treated with one, two, or three oral antidiabetes drugs (OADs) and associated levels of glycemic control.
This was a retrospective cohort study based on 81,573 people with type 2 diabetes in the U.K. Clinical Practice Research Datalink between January 2004 and December 2006, with follow-up until April 2011.
In people with HbA1c ≥7.0, ≥7.5, or ≥8.0% (≥53, ≥58, or ≥64 mmol/mol), median time from above HbA1c cutoff to intensification with an additional OAD was 2.9, 1.9, or 1.6 years, respectively, for those taking one OAD and >7.2, >7.2, and >6.9 years for those taking two OADs. Median time to intensification with insulin was >7.1, >6.1, or 6.0 years for those taking one, two, or three OADs. Mean HbA1c at intensification with an OAD or insulin for people taking one, two, or three OADs was 8.7, 9.1, and 9.7%. In patients taking one, two, or three OADs, median time from treatment initiation to intensification with an OAD or insulin exceeded the maximum follow-up time of 7.2 years. The probability of patients with poor glycemic control taking one, two, or three OADs, intensifying at end of follow-up with an OAD, was 21.1-43.6% and with insulin 5.1-12.0%.
There are delays in treatment intensification in people with type 2 diabetes despite suboptimal glycemic control. A substantial proportion of people remain in poor glycemic control for several years before intensification with OADs and insulin.
确定接受一种、两种或三种口服抗糖尿病药物（OAD）治疗的2型糖尿病患者强化治疗的时间以及相关的血糖控制水平。
这是一项回顾性队列研究，基于2004年1月至2006年12月期间英国临床实践研究数据链中的81573例2型糖尿病患者，随访至2011年4月。
对于糖化血红蛋白（HbA1c）≥7.0%、≥7.5%或≥8.0%（≥53、≥58或≥64 mmol/mol）的患者，服用一种OAD的患者从上述HbA1c临界值到加用另一种OAD强化治疗的中位时间分别为2.9年、1.9年或1.6年，服用两种OAD的患者则分别>7.2年、>7.2年和>6.9年。服用一种、两种或三种OAD的患者开始使用胰岛素强化治疗的中位时间分别>7.1年、>6.1年或6.0年。服用一种、两种或三种OAD的患者在加用OAD或胰岛素强化治疗时的平均HbA1c分别为8.7%、9.1%和9.7%。服用一种、两种或三种OAD的患者从开始治疗到加用OAD或胰岛素强化治疗的中位时间超过了7.2年的最长随访时间。血糖控制不佳的服用一种、两种或三种OAD的患者在随访结束时加用OAD强化治疗的概率为21.1% - 43.6%，加用胰岛素强化治疗的概率为5.1% - 12.0%。
尽管血糖控制未达最佳，但2型糖尿病患者的治疗强化存在延迟。相当一部分患者在加用OAD和胰岛素强化治疗前，血糖控制不佳的状态会持续数年。
