Early intensification of diabetes therapy after metformin failure is beneficial

Intensification of therapy within 6 months of metformin monotherapy failure resulted in rapid attainment of A1c goals.
Intensification of therapy within 6 months of metformin monotherapy failure resulted in rapid attainment of A1c goals.

Many patients with newly diagnosed type 2 diabetes do not intensify therapy within 6 months of metformin monotherapy failure, according to recent data published in Diabetes Care.

Kevin M. Pantalone, DO, from the Cleveland Clinic in Ohio, and colleagues used electronic health records from the clinic to identify patients recently diagnosed with type 2 diabetes between 2005 and 2013. Patients failed to reach their A1c goal after 3 months of metformin therapy, and the patients had A1c goals of 7% (n=1168), 7.5% (n=679), or 8% (n=429).

 

The researchers conducted a time-dependent survival analysis to measure the time until A1c attainment among patients who received early intensified therapy within 6 months of metformin failure compared with the time of A1c goal attainment among patients who received late intensified therapy after 6 months of metformin therapy.

Treatment was intensified within 6 months of metformin therapy in 62% of patients when poor glycemic control was defined as A1c >7%, in 69% of patients with poor glycemic control >7.5% A1c, and in 72% of patients with poor glycemic control >8% A1c.

Patients were more likely to undergo an early intensification of therapy if they were in a higher A1c category. In addition, patients who underwent early intensification therapy attained their A1c more rapidly than did those who underwent later intensification therapy.

Reference

  1. Pantalone KM, Wells BJ, Chagin Km, et al. Intensification of diabetes therapy and time until A1c goal attainment among patients with newly diagnosed type 2 diabetes who fail metformin monotherapy within a large integrated health system. Diabetes Care. 2016; doi: 10.2337/dc16-0227.
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