Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study

Tamara K. Young , Carinna Hockham , Louisa Sukkar , Amy Kang , Min Jun , Celine Foote , Jannah Baker , Kris Rogers , Sophia Zoungas , Alan Cass , David Sullivan , Meg J. Jardine , on behalf of the EXTEND45 Steering Commitee
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Abstract

Background

Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence.

Methods

We performed an episode-based analysis of the EXTEND-45 dataset, assessing trends in glucose lowering therapy and the associated outcomes of HbA1c and treatment persistence. Trends from 2009 to 2014 were assessed for each intensity level of a glucose lowering therapy regimen, according to the year prescribed. Episodes were defined as the length of time that an individual adhered to a regimen through ongoing prescription, and this was used as to define persistence. Mean HbA1c were calculated for each episode. Persistence and HbA1c were compared across the different regimens of treatment intensity.

Results

The intensity of glucose lowering therapy remained stable over time with around one third of episodes utilising a single glucose lowering agent. Mean HbA1c was higher for insulin-based treatment (mean 7.9 % SD = 1.3 %), and lowest for episodes of no glucose lowering treatment (mean 6.3 % (SD = 0.8 %). Around half of participants achieved glycemic targets of 7 %. While there was considerable variation in persistence, the median persistence was around 3 months (94 days, IQR 51–201 days).

Conclusions

Therapeutic intensity for diabetes has remained stable over 9 years. Whilst there was considerable variability in persistence with glucose lowering regimens, the mean duration of all regimens was less than a year. Requirement for higher intensity treatment with insulin was related to poorer glycemic control.

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降血糖方案在现实世界糖尿病管理中的持续时间和有效性:来自澳大利亚EXTEND45相关队列研究的数据
背景:糖尿病是一种常见病,通常需要增加降糖方案的强度。我们描述了方案强度的人群趋势,以及实现的HbA1c与治疗持久性的关系。方法:我们对EXTEND-45数据集进行了基于事件的分析,评估了降糖治疗的趋势、HbA1c的相关结果和治疗持久性。从2009年到2014年的趋势是根据规定的年份对每个降糖治疗方案的强度水平进行评估。发作被定义为个体通过持续的处方坚持一种方案的时间长度,这被用来定义持久性。计算每次发作的平均HbA1c。比较不同治疗强度方案的持久性和HbA1c。结果降糖治疗的强度随着时间的推移保持稳定,大约三分之一的发作使用单一的降糖药物。胰岛素治疗组平均HbA1c较高(平均7.9% SD = 1.3%),无降糖治疗组平均HbA1c最低(平均6.3% SD = 0.8%)。大约一半的参与者达到了7%的血糖目标。虽然持续时间有相当大的差异,但中位持续时间约为3个月(94天,IQR为51-201天)。结论糖尿病的治疗强度在9年内保持稳定。虽然降糖方案的持久性存在相当大的差异,但所有方案的平均持续时间都不到一年。需要高强度胰岛素治疗与较差的血糖控制有关。
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来源期刊
Endocrine and Metabolic Science
Endocrine and Metabolic Science Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
2.80
自引率
0.00%
发文量
4
审稿时长
84 days
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