By Colin Kenny, GP, Dromore
The 2009 NICE guideline on the management of type 2 diabetes recommended a step-wise approach to prescribing, with metformin being initiated first, followed by sulfonylureas. Here, investigators examined how closely this guidance was adhered to. They extracted data from the Clinical Practice Research Datalink from 1 January 2000 to 30 June 2012, evaluating average HbA1c values at treatment initiation and at progression to a second- or third-line treatment, including insulin.
They identified 123,671 individuals with at least one recorded HbA1c level. Metformin was the first prescription in 80% of cases (with a mean HbA1c of 72 mmol/mol [8.7%] prior to initiation). Sixteen per cent received sulfonylureas first line. Overall 78% of people were managed in line with one of the treatment pathways recommended by NICE. Those prescribed insulin second line after metformin had a mean HbA1c of 87 mmol/mol (10.1%) prior to their first prescription of insulin.
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