TY - JOUR
T1 - Intensification of medical management in type 2 diabetes
T2 - A real-world look at primary care practice
AU - Zekarias, Kidmealem
AU - Davey, Cynthia
AU - Seaquist, Elizabeth
N1 - Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Aims: To determine which drugs were selected to be added to metformin for patients on dual anti-diabetic medication in the management of type 2 diabetes and to assess HbA1c and BMI outcomes at 6 and 12 months after the initiation of a second anti-diabetic medication. Methods: A retrospective chart review of electronic medical record data. Second line anti-diabetic medication added to metformin between 7/1/2012 to 8/31/2017 in the primary care practice in Fairview Health System in Minnesota. Results: 3413 patients met the selection criteria of type 2 diabetes, 18 years and older, dual anti-diabetes therapy with metformin being the first prescribed. The most frequently prescribed medications added to metformin were sulfonylurea and basal insulin accounting for 51% (1724/3413) and 37% (1268/3413) respectively. Mean HbA1c reductions at 6 and 12 months among 2134 patients with baseline and follow-up HbA1c data respectively were: GLP-1 agonist (−1.3, P < 0.001; −1.2, P < 0.001), sulfonylurea (−1.1, P < 0.001; −0.9, P < 0.001), basal insulin (−1.1, P < 0.001; −1.0, P < 0.001), DPP4 inhibitor (−0.7, P = 0.223; −0.8, P = 0.049). Patients prescribed a GLP-1 agonist had a higher mean baseline BMI (BMI =40.3 kg/m2) and this was the only group with a statistically significant BMI reduction from baseline at 6 and 12 months (−1.5, P = 0.049 and −1.8, P = 0.041). Conclusion and relevance: Type 2 diabetes patients treated with sulfonylurea, basal insulin and GLP-1 agonist as an add on to metformin had significant reductions in HbA1c. Patients prescribed a GLP-1 agonist had a significant BMI reduction.
AB - Aims: To determine which drugs were selected to be added to metformin for patients on dual anti-diabetic medication in the management of type 2 diabetes and to assess HbA1c and BMI outcomes at 6 and 12 months after the initiation of a second anti-diabetic medication. Methods: A retrospective chart review of electronic medical record data. Second line anti-diabetic medication added to metformin between 7/1/2012 to 8/31/2017 in the primary care practice in Fairview Health System in Minnesota. Results: 3413 patients met the selection criteria of type 2 diabetes, 18 years and older, dual anti-diabetes therapy with metformin being the first prescribed. The most frequently prescribed medications added to metformin were sulfonylurea and basal insulin accounting for 51% (1724/3413) and 37% (1268/3413) respectively. Mean HbA1c reductions at 6 and 12 months among 2134 patients with baseline and follow-up HbA1c data respectively were: GLP-1 agonist (−1.3, P < 0.001; −1.2, P < 0.001), sulfonylurea (−1.1, P < 0.001; −0.9, P < 0.001), basal insulin (−1.1, P < 0.001; −1.0, P < 0.001), DPP4 inhibitor (−0.7, P = 0.223; −0.8, P = 0.049). Patients prescribed a GLP-1 agonist had a higher mean baseline BMI (BMI =40.3 kg/m2) and this was the only group with a statistically significant BMI reduction from baseline at 6 and 12 months (−1.5, P = 0.049 and −1.8, P = 0.041). Conclusion and relevance: Type 2 diabetes patients treated with sulfonylurea, basal insulin and GLP-1 agonist as an add on to metformin had significant reductions in HbA1c. Patients prescribed a GLP-1 agonist had a significant BMI reduction.
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U2 - 10.1016/j.jdiacomp.2019.107477
DO - 10.1016/j.jdiacomp.2019.107477
M3 - Article
C2 - 31711841
AN - SCOPUS:85075495427
SN - 1056-8727
VL - 34
JO - Journal of Diabetes and Its Complications
JF - Journal of Diabetes and Its Complications
IS - 1
M1 - 107477
ER -