By Colin Kenny, Editor – Diabetes Distilled
In this retrospective analysis, investigators evaluated the association between timing of treatment intensification and resultant glycaemic control in patients with type 2 diabetes who had not managed to sufficiently lower their HbA1c levels with monotherapy. They analysed a large UK database for intensification of treatment, defined as the initiation of one or more noninsulin anti-diabetes medications in addition to metformin or a sulfonylurea and discovered that, after adjustment for baseline differences, the patients were more likely to attain glycaemic control if their treatment was intensified early.
This study was a retrospective analysis of 93,515 patients with type 2 diabetes in the UK Clinical Practice Research Datalink database who had one or more HbA1c measurements ≥53 mmol/mol (≥7%) after 3 months or more of monotherapy with metformin or sulfonylurea. Intensification was stratified as early (<12 months), intermediate (12 to <24 months) or late (24 to <36 months) and was defined as the addition of one or more non-insulin antidiabetic medications to metformin or a sulfonylurea.
They discovered that the median time from treatment intensification to glycaemic control increased with increasing time before treatment intensification, being 20.0, 24.1 and 25.7 months for the early, intermediate and late intensification cohorts, respectively. After adjusting for baseline differences, compared to early intensification, patients in the intermediate and late intensification groups were 22% and 28% less likely to attain glycaemic control.
Investigators noted that regardless of whether first-line treatment is metformin or a sulfonylurea, earlier treatment intensification is associated with a shorter time to subsequent glycaemic control.
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