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ISSUES IN GLYCEMIC CONTROL

Why are nearly 1 in 2 patients with T2DM still not reaching the ADA-recommended HbA1c target?*

Despite the increased availability of resources, education, and treatments, the percentage of patients who are not well controlled (HbA1c ≥7.0%) remains high1-3,*

  • Approximately 40 treatments for T2DM have become available since 20002,3,†
  • About 47.8% of the 21 million Americans diagnosed with diabetes4approximately 10 million non-pregnant adult patients—are still not reaching the ADA’s general HbA1c target of <7.0%.1,4,5,*

Study Design: This retrospective analysis used survey and blood test data from NHANES collected from 1999 through 2010. Records from 3355 patients who had received a diagnosis of diabetes from a healthcare provider were included. NHANES uses stratified, multistage, probability-cluster techniques to ensure that the survey data collected are from a representative patient sampling. Analyses were confined to persons with a self-reported diagnosis of diabetes. Study Limitations: Recall and social-desirability bias are inherent limitations of self-reported data.1

*For non-pregnant healthy adults, the ADA recommends an HbA1c target of <7.0%. However, HbA1c targets are individualized for each patient.5

As of December 2016.

In actual clinical practice, treatment intensification occurs long after ADA guidelines recommend

  • Guidelines by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend healthy eating, weight control, increased physical activity, and diabetes education as a foundation for T2DM management throughout the course of treatment.5,6
  • ADA guidelines recommend titrating or adding therapies every 3 months in patients who are not reaching their glycemic target5
  • However, a large cohort study found that treatment intensification doesn’t always follow recommended practice7
    • In patients uncontrolled on 1 OAD, the addition of another OAD took 1.6 to 2.9 years
    • In patients uncontrolled on 3 OADs, insulin was introduced 6-7 years after the time poor glycemic control was identified (HbA1c ≥7.0%)

Study Design: A Clinical Practice Research Datalink (CPRD) retrospective database cohort analysis of patients (N=5677) with T2DM uncontrolled on 3 OADs, with HbA1c ≥8.0%, evaluated median time to add insulin from January 2004 to December 2006. Mean HbA1c reached 9.0% at the time of treatment escalation. CPRD is the world’s largest computerized database of its kind, comprising primary care records of >13 million patients in the United Kingdom. Although there are some limitations to the study with regard to patient characteristics and drug intensification, the database can be considered a representative sample.7

AACE=American Association of Clinical Endocrinologists; ADA=American Diabetes Association; HbA1c=glycated hemoglobin; NHANES=National Health and Nutrition Examination Survey; OADs=oral antidiabetics; T2DM=type 2 diabetes mellitus

Could you do more to help your patients who aren’t reaching their individualized glycemic target?

References:

1.Ali MK, Bullard KM, Saaddine JB, et al. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;368:1613-1624. doi:10.1056/NEJMsa1213829. 2.US Food and Drug Administration. FDA-approved diabetes medicines. http://www.fda.gov/ForPatients/Illness/Diabetes/ucm408682.htm. Accessed January 17, 2017.3. 2016 FDA Approved Drugs. CenterWatch. http://www.centerwatch.com/drug-information/fda-approved-drugs/. Accessed January 17, 2017. 4. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. 5. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2016;39(Suppl.1):S1-S112. 6. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 executive summary. Endocr Pract. 2016;22(1):84-113. 7. Khunti K, Wolden ML, Thorsted BL, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36(11):3411-3417. doi:10.2337/dc13-0331.