Sriphrapradang Chutintorn, Thakkinstian Ammarin, Chinthammit Ratiporn, Nayak Gurudutt
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Diabetes Investig. 2025 Jun;16(6):1010-1019. doi: 10.1111/jdi.14409. Epub 2025 Mar 12.
The CONVERGE (Cardiovascular Outcomes and Value in the Real-World with GLP-1RAs) study characterized demographics, clinical characteristics, and medication use in treatment-intensified (add-on to metformin) adults with type 2 diabetes (T2D) in Thailand.
A retrospective cross-sectional study of data from medical records (Jul 26, 2013, to Dec 31, 2017) was descriptively summarized for overall population and subgroups defined by glucose-lowering agent (GLA) classes.
Data from 1,000 adults were collected in reverse chronological order. At baseline, the mean (SD) age was 60 (12) years, HbA was 8.0%, and the median (IQR) T2D duration was 1.0 (0.2-2.4) years. Patients taking SGLT2-is (sodium glucose cotransporter-2 inhibitors) had a longer T2D duration (1.8 years, 0.8-3.2), GLP-1RAs (glucagon-like peptide-1 receptor agonists) had a higher body mass index of 32.0 (8.84) kg/m, and insulin subgroup had a higher HbA 8.5% (7.5-10.1). The utilization of GLP-1 RAs/SGLT-2is was low (1.5% and 6%, respectively). Among the subgroups, most patients in the GLP-1RA (80.0%) and insulin subgroup (81.3%) receiving 3/≥4 GLAs. The most frequently prescribed GLAs post-metformin were sulfonylureas (45.2%) and dipeptidyl peptidase-4 inhibitors (39.4%). Overall, 90% received ≥1 cardiovascular (CV) medication; lipid-lowering agents (78%) were the most prescribed.
These results indicate low utilization of GLAs with CV benefits, attributed to a lack of CV benefit data during the study period and partial reimbursement implementation. Future studies must identify barriers to adoption and estimate the usage of these GLAs with CV benefits as more evidence becomes available on positive CV outcomes to improve patient care in Thailand.
CONVERGE（胰高血糖素样肽-1受体激动剂在2型糖尿病患者现实世界中的心血管结局和价值）研究对泰国强化治疗（二甲双胍基础上加用其他药物）的2型糖尿病（T2D）成年患者的人口统计学特征、临床特征及药物使用情况进行了描述。
对2013年7月26日至2017年12月31日医疗记录中的数据进行回顾性横断面研究，按降糖药物（GLA）类别对总体人群及亚组进行描述性总结。
以倒序时间顺序收集了1000名成年患者的数据。基线时，平均（标准差）年龄为60（12）岁，糖化血红蛋白（HbA）为8.0%，T2D病程中位数（四分位间距）为1.0（0.2 - 2.4）年。服用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2-i）的患者T2D病程较长（1.8年，0.8 - 3.2），服用胰高血糖素样肽-1受体激动剂（GLP-1RA）的患者体重指数较高，为32.0（8.84）kg/m²，胰岛素亚组的HbA为8.5%（7.5 - 10.1）。GLP-1RA和SGLT2-i的使用率较低（分别为1.5%和6%）。在亚组中，接受3种/≥4种GLA治疗的患者，GLP-1RA亚组（80.0%）和胰岛素亚组（81.3%）占比最高。二甲双胍之后最常处方的GLA是磺脲类药物（45.2%）和二肽基肽酶-4抑制剂（39.4%）。总体而言，90%的患者接受了≥1种心血管（CV）药物治疗；降脂药物的处方率最高（78%）。
这些结果表明具有心血管益处的GLA使用率较低，这归因于研究期间缺乏心血管益处数据以及部分报销政策的实施。随着更多关于心血管阳性结局的证据出现，未来的研究必须确定采用这些药物的障碍，并估计具有心血管益处的这些GLA的使用情况，以改善泰国的患者护理。
