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. This study is the first in a series to assess treatment in a real world setting by comparing outcomes in patients with uncontrolled T2DM receiving 2 oral antidiabetic (OAD) therapies, GLP-1RAs, 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 2 OAD’s, GLP-1RAs, or BI were selected (initiation of 2 OAD’s, GLP-1RAs, 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: In total 75,366 patients met the inclusion criteria (48,965 2 OAD’s, 20,457 GLP-1RAs, and 5,944 BI). The BI cohort had a higher baseline HbA1c mean [SD, median] (10.6 [2.3, 10.4]) vs the 2 OAD’s (10.1 [2.5, 9.3]) or GLP-1RAs cohorts (10.1 [2.5, 9.3]) (P<0.0001). The BI cohort had the largest decrease in HbA1c during follow-up (i.e., decrease of 3.2% for BI indicating a 30.2% change, 2.9/28.7% for 2 OAD’s, and 2.7/26.7% for GLP-1RAs). Despite such marked HbA1c decrease, 58.2% of patients in the BI cohort, 51.5% in the 2 OAD’s cohort and 53.5% in the GLP-1RAs cohort had Hba1c > 8.0% during follow-up.
CONCLUSIONS: In a large clinical practice database, despite improvements in HbA1c with stepwise diabetes management, over half of patients had HbA1c > 8% during follow-up, advocating the desirability of new treatment options that can provide robust and sustained glycemic control.
