New drugs did not change overall glycemic control in U.S. patients with type 2 diabetes, study finds
The proportion of type 2 diabetes patients with HbA1c levels of 9% or greater or HbA1c between 8% and 9% increased from 2006 to 2013, while the proportion with an HbA1c less than 6% decreased.
Glucose management changed substantially in recent years, but overall glycemic control and hypoglycemia rates were largely unaffected in patients with type 2 diabetes, according to a new study.
Using a national database, researchers assessed trends in the use of different glucose-lowering drugs, glycemic control, and rates of severe hypoglycemia among privately insured and Medicare Advantage patients with type 2 diabetes. Results were published online on Sept. 22 by Diabetes Care.
The cohort included 1,657,610 adult patients who met criteria for type 2 diabetes during at least 1 year of the study period (2006 to 2013). Researchers looked at the proportion of the study population with 1 or more pharmacy fills for glucose-lowering medications, patients' glycemic control category, and rates of severe hypoglycemia requiring an ED visit, hospital admission, or observation stay.
During the study period, utilization increased for metformin (47.6% to 53.5%), dipeptidyl peptidase-4 inhibitors (0.5% to 14.9%), glucagon-like peptide-1 agonists (3.3% to 5.0%), and insulin (17.1% to 23.0%), while declining for sulfonylureas (38.8% to 30.8%) and thiazolidinediones (28.5% to 5.6%) (P<0.001 for all). The proportion of patients who did not fill any glucose-lowering medications declined slightly, from 25.7% to 24.1% (P<0.001).
Among the 25.6% of patients who had HbA1c levels available, the proportion of those with HbA1c of 9% or greater and HbA1c between 8% and 9% increased over the study period, from 9.9% to 12.2% and 9.9% to 10.6%, respectively (P<0.001). The proportion with an HbA1c less than 6% decreased during the study (15.3% to 13.1%; P<0.001), and there was a trend toward fewer having an HbA1c between 6% and 7%. No significant change was seen in the percentage of patients with HbA1c between 7% and 8% (23.8% to 23.0%; P=0.31).
The proportion of patients with HbA1c less than 7% declined from 56.4% in 2006 to 54.2% in 2013 (P<0.001). Poor glycemic control (HbA1c of 9% or above) was most common among the youngest patients and those without comorbidities but increased slightly over time across all age and comorbidity subgroups, the study found.
The age- and sex-standardized rate of hypoglycemia among those who filled at least 1 diabetes prescription was 1.3 events per 100 person-years in both 2006 and 2013. The oldest patients and those with multiple comorbidities had the highest rates of severe hypoglycemia. “These findings raise questions about the value of the observed shifts in drug utilization toward newer and costlier medications,” the study authors wrote.
They noted limitations to their analyses, such as how the sample of privately insured U.S. patients may not be representative of all U.S. patients. In addition, the database included an increasing number of patients over time, which required data standardization by age, race, sex, and region that may have incompletely captured changes in the types of patients in the study.