Blonde Lawrence, Raccah Denis, Lew Elisheva, Meyers Juliana, Nikonova Elena, Ajmera Mayank, Davis Keith L, Bertolini Monica, Guerci Bruno
Department of Endocrinology, Ochsner Medical Center, New Orleans, LA, USA.
University Hospital Sainte Marguerite, Marseille, France.
Diabetes Ther. 2018 Jun;9(3):1169-1184. doi: 10.1007/s13300-018-0429-x. Epub 2018 Apr 19.
Treatment guidelines recommend a stepwise approach to glycemia management in patients with type 2 diabetes (T2D), but this may result in uncontrolled glycated hemoglobin A1c (HbA1c) between steps. This retrospective analysis compared clinical and economic outcomes among patients with uncontrolled T2D initiating two oral antidiabetes drugs (OADs), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or basal insulin in a real-world setting.
Adults with T2D on OAD monotherapy were identified in the MarketScan claims database (2007-2014). Those initiating two OADs (simultaneously or sequentially), GLP-1 RAs, or basal insulin were selected (date of initiation was termed the 'index date'); patients were required to have HbA1c > 7.0% in the 6 months pre-index date. HbA1c was compared from 6 months pre- to 1-year post-index. Annual all-cause healthcare utilization and costs were reported over the 1-year follow-up period.
Data for 6054 patients were analyzed (2-OAD, n = 4442; GLP-1 RA, n = 361; basal insulin, n = 1251). Baseline HbA1c was high in all cohorts, but highest in the basal-insulin cohort. Treatment initiation resulted in reductions in HbA1c in all cohorts, which was generally maintained throughout the follow-up period. Average HbA1c reductions from the 6 months pre- to 1 year post-index date were -1.2% for GLP-1 RA, -1.6% for OADs, and -1.8% for basal insulin. HbA1c < 7.0% at 1 year occurred in 32.6%, 47.5%, and 41.1% of patients, respectively. Annual healthcare costs (mean [SD]) were lowest for OAD (US$10,074 [$22,276]) followed by GLP-1 RA (US$14,052 [$23,829]) and basal insulin (US$18,813 [$37,332]).
Despite robust HbA1c lowering following treatment initiation, many patients did not achieve HbA1c < 7.0%. Basal insulin, generally prescribed for patients with high baseline HbA1c, was associated with a large reduction in HbA1c and with higher costs. Therapy intensification at an appropriate time could lead to clinical and economic benefits and should be investigated further.
Sanofi U.S., Inc.
治疗指南推荐对2型糖尿病（T2D）患者采用逐步管理血糖的方法，但这可能导致各阶段之间糖化血红蛋白A1c（HbA1c）控制不佳。这项回顾性分析比较了在现实环境中起始两种口服抗糖尿病药物（OAD）、胰高血糖素样肽-1受体激动剂（GLP-1 RA）或基础胰岛素治疗的T2D控制不佳患者的临床和经济结局。
在MarketScan理赔数据库（2007 - 2014年）中识别接受OAD单药治疗的成年T2D患者。选择起始两种OAD（同时或序贯）、GLP-1 RA或基础胰岛素的患者（起始日期称为“索引日期”）；要求患者在索引日期前6个月的HbA1c>7.0%。比较索引日期前6个月至索引日期后1年的HbA1c。报告1年随访期内的年度全因医疗保健利用率和费用。
分析了6054例患者的数据（两种OAD组，n = 4442；GLP-1 RA组，n = 361；基础胰岛素组，n = 1251）。所有队列的基线HbA1c都很高，但基础胰岛素队列中最高。治疗起始导致所有队列的HbA1c降低，且在整个随访期内通常得以维持。索引日期前6个月至索引日期后1年的平均HbA1c降低幅度为：GLP-1 RA组-1.2%，OAD组-1.6%，基础胰岛素组-1.8%。1年后HbA1c<7.0%的患者分别占32.6%、47.5%和41.1%。年度医疗保健费用（均值[标准差]）以OAD组最低（10,074美元[22,276美元]），其次是GLP-1 RA组（14,052美元[23,829美元]）和基础胰岛素组（18,813美元[37,332美元]）。
尽管治疗起始后HbA1c显著降低，但许多患者未达到HbA1c<7.0%。通常为基线HbA1c高的患者开具基础胰岛素，其与HbA1c大幅降低及更高费用相关。在适当时间强化治疗可能带来临床和经济效益，应进一步研究。
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