Jude Edward B, O'Leary Caroline, Myland Melissa, Nixon Mark, Gooch Nick, Shaunik Alka, Lew Elisheva
Diabetes Centre Tameside General Hospital Ashton-under-Lyne UK.
IQVIA London UK.
Endocrinol Diabetes Metab. 2019 Sep 29;3(1):e00094. doi: 10.1002/edm2.94. eCollection 2020 Jan.
Many patients with type 2 diabetes mellitus (DM) fail to achieve glycaemic control despite recommended treatment strategies to reduce glycated haemoglobin (HbA1c). This real-world retrospective cohort study compared HbA1c change and treatment patterns between those intensifying and not intensifying therapy with oral antidiabetic drugs (OADs).
Patients suboptimally controlled on OADs (>58 mmol/mol [>7.5%] or >64 mmol/mol [>8.0%] for high risk, index 1) were included from IQVIA Medical Research Data. Intensifiers within 12 months of index 1 were matched (1:1) to nonintensifiers. Primary outcomes were HbA1c change and proportion of participants achieving HbA1c targets 6 and 12 months post-index 2 (date of intensification [intensifiers] or pseudodate [nonintensifiers]). Therapy adherence was also assessed.
A total of 10 832 participants (5539 intensifiers and 5293 nonintensifiers) were included. Mean HbA1c decrease from baseline to 6 months was -1.13% (intensifiers) vs -0.75% (nonintensifiers), with no substantial further change at 12 months. Cox proportional hazards (PH) analysis suggested a nearly 20% greater chance of target achievement at 6 months for intensifiers vs nonintensifiers (hazard ratio [HR]: 0.79 [95% confidence interval [CI]: 0.73-0.86]), which was similar at 12 months (HR: 0.80 [95% CI: 0.74-0.86]). Intensifiers tended towards greater adherence to baseline therapy (90% [standard deviation (SD): 14.9] vs nonintensifiers 87% [SD: 16.0]), which decreased following intensification.
Significant reductions in HbA1c were evident at 6 months and were greater in intensifiers vs nonintensifiers. Little additional clinical benefit was seen 12 months postintensification. Despite good treatment adherence, many participants failed to achieve target HbA1c; actions beyond improved adherence are needed to improve suboptimal HbA1c.
尽管有推荐的治疗策略来降低糖化血红蛋白（HbA1c），但许多2型糖尿病（DM）患者仍未能实现血糖控制。这项真实世界的回顾性队列研究比较了使用口服抗糖尿病药物（OADs）强化治疗和未强化治疗患者的HbA1c变化及治疗模式。
从IQVIA医学研究数据中纳入OADs治疗效果欠佳（高危患者HbA1c>58 mmol/mol[>7.5%]或>64 mmol/mol[>8.0%]，索引1）的患者。索引1后12个月内的强化治疗患者与未强化治疗患者进行1:1匹配。主要结局为索引2后6个月和12个月（强化治疗日期[强化治疗组]或虚拟日期[未强化治疗组]）的HbA1c变化以及达到HbA1c目标的参与者比例。同时评估治疗依从性。
共纳入10832名参与者（5539名强化治疗组和5293名未强化治疗组）。从基线到6个月，强化治疗组HbA1c平均下降1.13%，未强化治疗组为0.75%，12个月时无显著进一步变化。Cox比例风险（PH）分析表明，强化治疗组在6个月时达到目标的可能性比未强化治疗组高近20%（风险比[HR]：0.79[95%置信区间[CI]：0.73 - 0.86]），12个月时情况相似（HR：0.80[95%CI：0.74 - 0.86]）。强化治疗组对基线治疗的依从性更高（90%[标准差（SD）：14.9]，未强化治疗组为（87%[SD：16.0]），强化治疗后依从性下降。
强化治疗组在6个月时HbA1c显著降低，且降幅大于未强化治疗组。强化治疗12个月后临床获益增加不多。尽管治疗依从性良好，但许多参与者仍未达到目标HbA1c；需要采取除改善依从性之外的措施来改善欠佳的HbA1c水平。
