Glucose-lowering drug use, glycemic outcomes, and severe hypoglycemia: 18-Year trends in 0·9 million adults with Diabetes in Hong Kong (2002–2019)

The Lancet Regional Health. Western Pacific

卷:26

Andrea O.Y. Luk¹  Hongjiang Wu¹  Juliana C.N. Chan²  Alice P.S. Kong³  Aimin Yang³  Xinge Zhang³  Mai Shi³  Elaine Chow³  Eric S.H. Lau³  Ronald C.W. Ma³  Baoqi Fan³ 

[1] Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China;

[2] Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China;

[3] Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region (SAR), China;

关键词: Glucose lowering drug;    Diabetes;    Glycemic control;    Hypoglycemia;    Trends;    Diabetes care;   

DOI  :  

来源: DOAJ

【 摘 要 】

Summary:Background: Improvements in glycemic outcomes have stalled since 2010 in several international surveys. We previously reported improvements in glycemic control in 2007-2014 in Hong Kong coinciding with primary care reforms, use of dipeptidyl-peptidase 4 inhibitors (DPP-4is) and metformin. The aim of this study was to estimate more recent trends in drug use and glycemic outcomes following introduction of newer classes of glucose-lowering drugs (GLDs). Methods: Using population-based data from the Hong Kong Diabetes Surveillance Database, we explored age-specific trends in proportion of patients reaching glycemic targets and incidence rates of severe hypoglycemia (SH) in 963,612 adults with diabetes in 2002-2019. We further assessed patterns of GLDs utilisation by presence of atherosclerotic-cardiovascular disease (ASCVD), heart failure, and estimated-glomerular filtration rate (eGFR). Findings: Following rapid decline in HbA1c from 7·7% to 7·2% in 2005-2014 (annual percentage change [APC]= -0·8, 95% CI:-1·0,-0·6), standardized mean HbA1c plateaued since 2014 (HbA1c 7·2% in 2019, APC=0·0, 95% CI:-0·2, 0·2). The incidence rates of SH declined from 3·4 to 0·7 events per 100-person years, but improvements levelled off since 2014. Use of metformin steadily increased (41·1 to 58·7%), sulfonylureas decreased (52·2 to 31·1%) while insulin remained static in 2002-2019. Adoption of DPP-4is slowed following initial rapid uptake in 2007-2011. DPP-4is remained the most widely prescribed newer GLD in all ages (14·3% in 2019). Use of glucagon-like-peptide 1 receptor agonists (GLP1-RAs) and sodium glucose co-transporter-2 inhibitors (SGLT2is) increased rapidly in 2015-2019 with 0·5% and 6% of users respectively in 2019. Interpretation: Following rapid improvement in 2007-2014, glycemic control and SH rates had plateaued despite changing patterns of newer GLDs use in Hong Kong. Funding: Dr. Aimin Yang was supported by a CUHK Impact Research Fellowship Scheme.

【 授权许可】

Unknown