Change in HbA1c associated with treatment intensification among patients with type 2 diabetes and poor glycemic control

Abstract

Objective: We conducted a retrospective cohort study to investigate the HbA1c change associated with treatment intensification in a real-world population of patients with type 2 diabetes (T2D).

Methods: Using a large US insurance claims database, patients aged ≥18 years with a T2D diagnosis and HbA1c ≥8.0% (64 mmol/mol) after ≥3 months of oral pharmacotherapy with metformin (± other oral antidiabetes agents) were identified (index date). Continuous enrollment was required for ≥12 months before (baseline) and after the index date with no baseline use of injectable antidiabetes drugs. We defined treatment intensification as prescriptions for injectable or additional oral antidiabetes drugs. Time to intensification was classified as timely (within 6 months) or not (≥6 months or not intensified). Linear regression models with propensity score 1:1 matching were performed to assess the effect of timely intensification on HbA1c.

Results: Of the 11,525 patients meeting the inclusion criteria, only 37% had treatment intensified within 6 months. Mean age at index date was 57 years, 40% of the sample was female. The mean baseline A1C was 9.4% and 9.0%, while post-index A1C was 7.9% and 8.2% for timely intensified patients versus not, respectively. Patients with timely intensification had significantly greater HbA1c reduction compared with others (−0.33%, 95% CI: −0.41% to −0.25%) within 1 year of follow up.

Conclusions: In this analysis of patients with T2D and treatment failure in a real-world setting, earlier treatment intensification was associated with better glycemic control as indicated by lower HbA1c values.

Keywords:

• Glycemic control
• HbA1c
• treatment intensification
• type 2 diabetes

Transparency

Declaration of funding

This work was supported by AstraZeneca Pharmaceuticals.

Author contributions: conception and design: A.Z.F. and J.J.S.; analysis and interpretation of data: A.Z.F. and J.J.S.; drafting of the paper: A.Z.F.; revising critically for intellectual content: A.Z.F. and J.J.S.; final approval of the version to be published: A.Z.F. and J.J.S. Both authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

A.Z.F. has disclosed that he has received research support from AstraZeneca Pharmaceuticals for this study. J.J.S. has disclosed that he was an employee of AstraZeneca Pharmaceuticals at the time this research was conducted.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

No assistance in the preparation of this article is to be declared.

Previous presentation: This study was presented at the American Diabetes Association’s 76th Scientific Sessions, New Orleans, LA, USA, 10–14 June 2016.