To inform patients and their carers about the probability of reducing HbA1c to clinically desirable levels and sustainability of such control over 2 years with major second-line anti-diabetic therapies under individual risk scenario, with and without third-line intensification.
Materials and Methods
From US Centricity Electronic Medical Records, 163,081 patients with type 2 diabetes aged 18-80 years, who initiated metformin; intensified with DPP-4 inhibitor (DPP-4i), GLP-1 receptor agonist (GLP-1RA), sulfonylurea, insulin, or thiazolidinedione; and continued second-line ≥ 6 month, were selected. Treatment groups were balanced on baseline characteristics and glycaemic achievements were estimated with logistic regression.
With HbA1c 7.5-7.9% at second-line initiation, the adjusted probabilities to achieve HbA1c <7% at 6 month were 32/ 38/ 39/ 26/ 38% in the sulfonylurea/ DPP-4i/ GLP-1RA/ insulin/ thiazolidinedione groups. With baseline HbA1c of 8-9%, the probabilities of reducing HbA1c <7.5% were 38/ 44/ 40/ 34/ 42% respectively. In these baseline HbA1c categories, the adjusted probabilities of sustaining HbA1c achievements over 2 years were higher in the GLP-1RA and thiazolidinedione groups, compared to sulfonylurea and insulin (p<0.01). With baseline HbA1c of 9.1-12%, 38% achieved HbA1c <7.5% at 6 months. The adjusted probability of sustaining this control over 2 years was higher in the incretins and thiazolidinedione groups (range: 62-75%), while insulin and sulfonylurea offered lower chances of sustainable control (range: 54-56%).
Patients treated with second-line incretins and thiazolidinedione had significantly higher probability of achieving and sustaining glycaemic control over two years without further intensification, compared to those treated with sulfonylurea or insulin.