Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus

Treatment Patterns in Patients With Newly Diagnosed Type 2 Diabetes in China: A Retrospective, Longitudinal Database Study

PURPOSE

The objectives of this study were to examine the patterns of antihyperglycemic drug (AHD) therapy among patients with newly diagnosed type 2 diabetes mellitus (T2DM) in the general Chinese population, stratified by initial hemoglobin (Hb) A_1c level, and to assess whether treatment patterns are consistent with the recommendations published in the China Diabetes Society's clinical treatment guideline.

METHODS

A retrospective database analysis was conducted, and data were obtained from the SuValue database. Prescribing patterns for diabetes treatments were determined from data obtained from the Nanhai District-based electronic medical records database, a subset of the SuValue database. Data from patients newly diagnosed with T2DM who also had at least 2 prescriptions for AHD medications after diagnosis and at least 1 HbA_1c test result during the 12 months prior to AHD treatment initiation, between January 1, 2004, and July 22, 2018, were included in the analysis. ANOVA, χ² test, and Kaplan-Meier survival analysis were used to examine differences between 4 initial-HbA_1c groups (<7%, 7%-<8%, 8%-<9%, and ≥9%).

FINDINGS

A total of 4712 patients were included, with women accounting for 47.8%; the mean age (SD) of the study population was 56.44 (12.57) years. Men were more likely to have had a higher HbA_1c level at initial AHD treatment (P < 0.0001). The first-line therapies most frequently prescribed were metformin combination (29.5%), followed by insulin-including treatment (25.9%), and metformin monotherapy (19.2%). Metformin monotherapy (29.5%) was most commonly prescribed in patients with an HbA_1c level of <7%; metformin combination (31.7%), in patients with an HbA_1c level of 7%-<8%; and insulin-containing treatment, in patients with HbA_1c levels of 8%-<9% (28.1%) and ≥9% (38.4%). Insulin-including treatment was more commonly prescribed than was metformin combination in patients with an initial HbA_1c level of ≥8% after initial treatment. In third- and fourth-line treatments, patients with an HbA_1c level of ≥8% more prevalently were prescribed metformin combination and insulin-including treatment, while metformin combination and "other" treatment were more generally prescribed in patients with an HbA_1c level of ≤8%. However, 8.8% of patients with an HbA_1c level of <7% were prescribed insulin-including treatment as first-line therapy. In all lines of treatment, the percentages of patients prescribed insulin were increased with initial HbA_1c levels. A similar pattern was seen with dipeptidyl peptidase 4 inhibitors after first-line treatment. Overall, the median time to treatment switch was shorter than 3 months.

IMPLICATIONS

The findings from the present study depict a comprehensive overview of AHD-treatment patterns in patients stratified by HbA_1c level. The current treatment practices observed were inconsistent the published guideline, in terms of recommendations on metformin monotherapy and insulin use in first-line therapy.