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Erschienen in:
01.10.2015 | Article
Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes
Erschienen in: Diabetologia | Ausgabe 10/2015
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Aims/hypothesis
The aims of this work were to assess glycaemic control in metformin users receiving their first add-on glucose-lowering therapy and to examine the real-life effectiveness of different add-on drugs.
Methods
We carried out a population-based cohort study using healthcare databases in northern Denmark during 2000–2012. We included 4,734 persons who initiated metformin monotherapy and added another glucose-lowering drug within 3 years. Attainment of recommended HbA1c goals within 6 months of add-on was investigated, using Poisson regression analysis adjusted for age, sex, baseline HbA1c, diabetes duration, complications and Charlson Comorbidity Index.
Results
Median metformin treatment duration at intensification was 12 months (interquartile range [IQR] 4–23 months) and pre-intensification HbA1c was 8.0% (IQR 7.2–9.2%) (64 [IQR 55–77] mmol/mol). Median HbA1c dropped 1.2% (13 mmol/mol) with a sulfonylurea (SU) add-on, 0.8% (9 mmol/mol) with a dipeptidyl peptidase-4 (DPP-4) inhibitor, 1.3% (14 mmol/mol) with a glucagon-like peptide-1 (GLP-1) receptor agonist, 0.9% (10 mmol/mol) with other non-insulin drugs and 2.4% (26 mmol/mol) with insulin. Compared with SU add-on, attainment of HbA1c <7% (<53 mmol/mol) was higher with GLP-1 receptor agonists (adjusted RR [aRR] 1.10; 95% CI 1.01, 1.19) and lower with DPP-4 inhibitors (aRR 0.94; 95% CI 0.89, 0.99), other drugs (aRR 0.86; 95% CI 0.77, 0.96) and insulin (aRR 0.88; 95% CI 0.77, 0.99). The proportion of metformin add-on users who attained HbA1c <7% (<53 mmol/mol) increased from 46% in 2000–2003 to 59% in 2010–2012, whereas attainment of HbA1c <6.5% (<48 mmol/mol) remained 30% among patients aged <65 years without comorbidities.
Conclusions/interpretation
Among early type 2 diabetes patients receiving their first metformin add-on treatment, HbA1c reduction with different non-insulin drugs is similar to, and comparable with, that observed in randomised trials, yet 41% do not achieve HbA1c <7% (<53 mmol/mol) within 6 months.