Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes

BMC Endocrine Disorders

Panagiotis Mavros³  Changgeng Zhao²  Michael J Davies²  Charles M Alexander²  Alan J Sinclair¹ 

[1] Beds & Herts Postgraduate Medical School, Luton, UK;Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA;Global Health Outcomes, Merck Sharp & Dohme Corp, Mail: WS2E76, 1 Merck Drive, Whitehouse Station, NJ 08889, USA

关键词: Antihyperglycaemic medication;    Type 2 diabetes mellitus;    Age;    Clinical inertia;   

Others  :  1086470
DOI  :  10.1186/1472-6823-12-1

 received in 2011-05-13, accepted in 2012-03-07,  发布年份 2012

【 摘 要 】

Aim

To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes.

Methods

In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date) and had at least 2 years of follow-up medical history (N = 9,158). Initiation of antihyperglycaemic medication (i.e., treatment) was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors.

Results

Mean (SD) HbA_1c at diagnosis was 8.1% (2.3). Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively). Among the treated patients, median (25^th, 75^th percentile) time to treatment initiation was 63 (8, 257) days. Of the patients with HbA_1c ≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA_1c also had shorter time to treatment initiation (adjusted hazard ratio (HR) = 2.44 [95% confidence interval (CI): 1.61, 3.70]; p < 0.0001). Increasing age (in years) was negatively associated with time to treatment initiation (HR = 0.98 [95% CI: 0.97, 0.99]; p < 0.001). Factors significantly associated with shorter time to treatment initiation included female gender and use of cardiovascular medications at baseline or initiated during follow up.

Conclusions

In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA_1c was the strongest factor associated with initiating antihyperglycaemic medication in these patients.

【 授权许可】

   
2012 Sinclair et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]National Collaborating Centre for Chronic Conditions: Type 2 diabetes: National clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians; 2008.
• [2]American Diabetes Association: Standards of medical care in diabetes-2011. Diabetes Care 2011, 34(1):S11-S61.
• [3]Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al.: Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2009, 52:17-30.
• [4]Olivarius N, Andreasen AH, Siersma V, Richelsen B, Beck-Nielsen H: Changes in patient weight and the impact of antidiabetic therapy during the first 5 years after diagnosis of diabetes mellitus. Diabetologia 2006, 49:2058-2067.
• [5]Olivarius N, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA: Randomised controlled trial of structured personal care of type 2 diabetes mellitus. BMJ 2001, 323:970-975.
• [6]Spoelstra JA, Stolk RP, Klungel OH, Erkens JA, Rutten GE, Leufkens HG, et al.: Initiation of glucose-lowering therapy in Type 2 diabetes mellitus patients in general practice. Diabet Med 2004, 21:896-900.
• [7]Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al.: Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008, 336:491-495.
• [8]Del Prato S, Penno G, Miccoli R: Changing the treatment paradigm for type 2 diabetes. Diabetes Care 2009, 32(2):S217-S222.
• [9]UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837-853.
• [10]UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998, 352:854-865.
• [11]Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359:1577-1589.
• [12]Turner RC, Cull CA, Frighi V, Holman RR: Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA 1999, 281:2005-2012.
• [13]Diabetes in the UK 2010: Key statistics on diabetes [http://www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf.] webcite
• [14]Lawrenson R, Coles G, Walton K, Farmer R: Characteristics of practices contributing to the MediPlus database and the implications for its use in epidemiological research. J Inform Prim Care 1998, 1:14-18.
• [15]National Collaborating Centre for Chronic Conditions: Management of type 2 diabetes: Managing blood glucose levels. London: Royal College of Physicians; 2002.
• [16]Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, et al.: Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 2009, 151:306-314.
• [17]Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, et al.: Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006, 29:1963-1972.
• [18]Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M: The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Pract 2002, 19:344-349.
• [19]Spain M, Edlund BJ: Pharmacological management of type 2 diabetes in newly diagnosed older adults. J Gerontol Nurs 2009, 35:16-21.
• [20]Zhang Q, Rajagopalan S, Marrett E, Davies MJ, Radican L, Engel SS: Time to treatment initiation with oral antihyperglycaemic therapy in US patients with newly diagnosed type 2 diabetes. Diabetes Obes Metab 2012, 14:149-154.
• [21]Zhang Q, Marrett E, Jameson K, Meiler S, Davies MJ, Radican L, et al.: Reasons given by general practitioners for non-treatment decisions in younger and older patients with newly diagnosed type 2 diabetes mellitus in the United Kingdom: A survey study. BMC Endocrine Disorders 2011, 11:17. BioMed Central Full Text
• [22]Brown AF, Mangione CM, Saliba D, Sarkisian CA: Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 2003, 51:S265-S280.