OBJECTIVES: Many treatment guidelines tend to recommend and clinicians usually follow a stepwise approach that may not be ideal as patients may experience uncontrolled HbA1c between steps. Achieving HbA1c control earlier and maintaining control longer is a key goal of T2DM treatment. To assess treatment in a real world setting, this study compared outcomes in patients with uncontrolled T2DM receiving 3 oral antidiabetic (OAD) therapies, GLP-1, or basal insulin (BI) with a retrospective electronic medical record database.
METHODS: Patients with a T2DM diagnosis between 1/1/2007 and 12/31/2014 were identified in the GE Centricity database. Patients receiving 3 OAD’s, GLP-1, or BI were selected (sequential or simultaneous initiation of 3 OAD’s, GLP-1, or BI termed index date). Patients were required to have 6 months pre- and 12 months post-index date physician history and a pre-index date HbA1c >7%. HbA1c was compared between the 6 months pre- and 12 months post-index date.
RESULTS: A total of 59,598 patients met the inclusion criteria (23,450 3 OAD’s, 8,023 GLP-1, and 28,125 BI). The BI cohort had a higher baseline HbA1c mean [SD, median] (9.7 [2.0, 9.2]) vs. 3 OAD’s (8.7 [1.5, 8.2]) or GLP-1 cohorts (8.7 [1.4, 8.3]) (P<0.0001). The BI cohort had the largest decrease in HbA1c during follow-up (i.e., decrease of 1.4% for BI indicating a 14.0% change, 0.85/9.8% for 3 OAD’s, and 0.9/10.3% for GLP-1). Despite such marked HbA1c decrease, 46.5% of patients in the BI cohort, 33.6% in the 3 OAD’s cohort and 34.1% in the GLP-1 cohort had Hba1c > 8.0% during follow-up.
CONCLUSIONS: In a large clinical practice database, despite improvements in HbA1c, over a third of patients had HbA1c > 8% during follow-up, advocating the desirability of new treatment options that could provide more robust and sustained glycemic control.
