Degree of control and delayed intensification of antihyperglycaemic treatment in type 2 diabetes mellitus patients in primary care in Spain

Objectives: Primary aim: to determine the degree of control of HbA(1c) at the time of treatment intensification (TI) in T2DM patients. Secondary aims: fasting plasma glucose levels; estimation of the elapsed time between HbA(1c) exceeding 7% and TI; antidiabetic combinations used, % patients with good cardiometabolic control (LDL-c < 100 mg/dL; SBP < 130 and DPB < 80 mmHg and HbA(1c) < 7%). Research design and methods: One-cohort, multicenter, retrospective, observational study conducted in Spain. Patients diagnosed with T2DM that had switched from monotherapy to combination antidiabetic therapy were evaluated at baseline and after one year of follow-up. Results: A total of 1202 T2DM patients were analyzed. At the time of TI: mean HbA(1c) 8.1%; median time of uncontrolled disease: 2.0 years. After one-year of TI: significant reduction in mean HbA(1c) (8.1% vs. 7.0%, p < 0.001) and a mean fasting plasma glucose levels reduction (181.1 mg/dL vs. 144.1 mg/dL, p < 0.001) was also observed. The percentage of patients under glycemic control (HbA(1c) < 7%) increased from 12.2% to 51.6% (p < 0.001). Most common antidiabetic combinations: metformin + sulfonylurea (44.1%) and metformin + thiazolidindione (15.9%). Conclusions: In the population of T2DM patients analyzed, TI was carried out when HbA(1c) values were above those recommended in clinical guidelines (<= 7%), with a delay of two years to address the second step of therapy, despite the consensus recommendation of the ADA/EASD of 3 months. TI was shown to be effective since addition of a second antidiabetic drug led to an average reduction of HbA(1c) of approximately 1%. Metformin was the drug most commonly used as monotherapy being the most frequent combination metformin + sulfonylurea. (C) 2010 Elsevier Ireland Ltd. All rights reserved.