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.
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
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.