medwireNews: Less than half of patients with type 2 diabetes and hypertension who are assigned to strict glycated hemoglobin (HbA1c) targets reach their goal within 12 months, German study data show.
Even with a lenient target, the proportion achieving it only reached around 60%, report Roland Schmieder (Universitätsklinikum Erlangen) and colleagues in Cardiovascular Diabetology.
Using data from the DIALOGUE registry, Schmieder et al identified patients aged 18 years or older with type 2 diabetes and hypertension for whom the treating physician considered blood glucose lowering medication to be inadequate and/or not safe or tolerable and chose to add a further oral drug or switch drug treatment to achieve glycemic control.
These patients were assigned a strict (≤6.5%; n=2644), intermediate (>6.5 to ≤7.0%; n=2912), or lenient (>7.0 to ≤7.5%; n=1135) HbA1c treatment target and followed up for 12 months.
The researchers found that patients with a strict HbA1c treatment target were significantly younger (mean 63.3 vs 66.2 and 66.3 years) and had significantly shorter diabetes duration (mean 6.1 vs 7.4 and 7.8 years) than those with intermediate or lenient targets, respectively.
They also had significantly less comorbidity, a significantly better quality of life, and were less likely to be receiving three or more oral antidiabetic drugs at baseline.
When the patients were split into baseline HbA1c tertiles, Schmieder and team observed that physicians tended to select a treatment target close to the baseline value.
At 12 months, 46.2% of patients with strict targets, 56.5% of those with intermediate targets, and 59.6% of those with lenient targets achieved their HbA1c goal.
The proportion reaching their target level decreased across baseline HbA1c tertiles, but patients with a higher baseline HbA1c value had a greater absolute reduction, regardless of their assigned target.
On multivariate analysis, patients with intermediate and lenient targets were a respective 5.31 and 3.02 times more likely to achieve their target than those assigned to the strict target group.
Older patients (above median) were significantly more likely to achieve their set target than younger ones, whereas longer diabetes duration, lower education level, and receipt of at least three oral antidiabetic drugs or insulin at baseline were all associated with a reduced likelihood for meeting the HbA1c target.
Schmieder and co-investigators also found that the proportion of patients using each specific antidiabetic drug changed very little over time, but insulin use increased slightly at 6 and 12 months in all patients regardless of whether of not they reached their treatment target.
This suggests “substantial clinical inertia,” they say.
The team concludes: “Achievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels.
“The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with [type 2 diabetes].”
By Laura Cowen
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