Antihyperglycemics in Patients With Newly Diagnosed T2DM
Antihyperglycemics in Patients With Newly Diagnosed T2DM
In the MediPlus database, 43,486 patients had a diagnosis of type 2 diabetes. Of the 11,543 who had their first observed diagnosis between 2003 and 2005, 9,158 patients (54% male) met the inclusion criteria for this analysis. Mean (SD) age was 62.4 (12.8) years, with 9.6%, 44.3%, 27.5%, and 18.6% of patients within the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively (Table 1). HbA1c values were available for 55% (n/N = 5,044/9,158) of the entire cohort. There was no association between age and missing HbA1c values (p = 0.3876 for trend using chi-square test). Mean (SD) HbA1c at diagnosis was 8.1% (2.3) for the cohort of patients with HbA1c values, and 8.7% (2.4), 8.3% (2.3), 8.0% (2.2), and 7.7% (2.0) for those in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively. The presence of pre-existing co-morbid conditions at baseline increased with age, except for liver disease where the opposite was observed (Table 1). During the follow-up period, newly diagnosed co-morbid conditions included cardiovascular conditions (5.7%), microvascular complications of diabetes (7.2%), cancer (1.8%), edema (1.7%), liver disease (0.5%), and Alzheimer's disease/dementia (0.2%). Use of antihypertensive and gastroprotective agents increased with age, whereas use of lipid-modifying agents was similar across age groups (Table 1). Newly prescribed medications during the follow-up included antihypertensive (10.1%), lipid-modifying (28.6%), weight-reducing (1.6%), and gastroprotective agents (6.3%).
Overall, 36%, 42%, and 51% of patients initiated antihyperglycaemic therapy within 180 days, 1 year, and 2 years of diagnosis, respectively. The proportion of patients who had treatment initiated within 2 years of diagnosis decreased with advancing age (65%, 55%, 46%, and 40% for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively). The median time to treatment initiation increased with advancing age (213, 530, > 730, and > 730 days for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively [Figure 1]). Among the treated patients, median (25, 75 percentile) time to treatment initiation was 63 (8, 257) days, with treatment initiation increasingly delayed with age. Of the treatments prescribed, 76% of patients were prescribed metformin, 19% sulphonylurea, 4% insulin, and 1% other. Metformin use decreased with age (77%, 82%, 76%, and 66%, for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively; p < 0.0001 for trend using chi-square test) and sulphonylurea use increased with age (15%, 15%, 22%, and 32%, respectively; p < 0.0001 for trend using chi-square test).
(Enlarge Image)
Figure 1.
Kaplan-Meier curves for time to initiation of antihyperglycaemic therapy after diagnosis of type 2 diabetes by age group.
Cox regression analysis adjusting for patients' baseline characteristics showed that increasing age was associated with longer time to initiation of antihyperglycaemic medication (Table 2). An HbA1c ≥ 7.5% at diagnosis was associated with shorter time to treatment initiation (Table 2). In this cohort of patients (i.e., HbA1c ≥ 7.5% at diagnosis, n = 2,446), 73%, 81%, and 87% initiated antihyperglycaemic therapy within 180 days, 1 year, and 2 years of diagnosis, respectively. There was a significant interaction between age and HbA1c at diagnosis such that the negative effect of age on treatment initiation was reduced in individuals with higher HbA1c values at diagnosis, i.e., ≥ 7.5% (Table 2). Other significant predictors associated with shorter time to antihyperglycaemic medication initiation included female gender, use of lipid-modifying agents, use of weight-reducing agents and later physician registration year. The missing indicator for HbA1c values was associated with shorter time to initiation (Table 2). During the follow-up period, development of cardiovascular conditions (Table 2), hospitalization, and new use of antihypertensive, lipid-modifying, gastroprotective, or weight-reducing agents were associated with shorter times to treatment initiation (Table 2).
Figure 2 illustrates that higher HbA1c values at the end of follow up were associated with lower levels of non-treatment with antihyperglycaemic medications. Within each HbA1c category there was a significant trend for patients in the older age groups to remain untreated (Figure 2). Among those untreated, the proportion of patients with an HbA1c ≥ 7.5% was not statistically different across age groups (p > 0.05).
(Enlarge Image)
Figure 2.
Proportion of patients untreated with antihyperglycaemic medication after the 2-year follow-up period by age group and last available HbA1c value.
Results
In the MediPlus database, 43,486 patients had a diagnosis of type 2 diabetes. Of the 11,543 who had their first observed diagnosis between 2003 and 2005, 9,158 patients (54% male) met the inclusion criteria for this analysis. Mean (SD) age was 62.4 (12.8) years, with 9.6%, 44.3%, 27.5%, and 18.6% of patients within the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively (Table 1). HbA1c values were available for 55% (n/N = 5,044/9,158) of the entire cohort. There was no association between age and missing HbA1c values (p = 0.3876 for trend using chi-square test). Mean (SD) HbA1c at diagnosis was 8.1% (2.3) for the cohort of patients with HbA1c values, and 8.7% (2.4), 8.3% (2.3), 8.0% (2.2), and 7.7% (2.0) for those in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively. The presence of pre-existing co-morbid conditions at baseline increased with age, except for liver disease where the opposite was observed (Table 1). During the follow-up period, newly diagnosed co-morbid conditions included cardiovascular conditions (5.7%), microvascular complications of diabetes (7.2%), cancer (1.8%), edema (1.7%), liver disease (0.5%), and Alzheimer's disease/dementia (0.2%). Use of antihypertensive and gastroprotective agents increased with age, whereas use of lipid-modifying agents was similar across age groups (Table 1). Newly prescribed medications during the follow-up included antihypertensive (10.1%), lipid-modifying (28.6%), weight-reducing (1.6%), and gastroprotective agents (6.3%).
Overall, 36%, 42%, and 51% of patients initiated antihyperglycaemic therapy within 180 days, 1 year, and 2 years of diagnosis, respectively. The proportion of patients who had treatment initiated within 2 years of diagnosis decreased with advancing age (65%, 55%, 46%, and 40% for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively). The median time to treatment initiation increased with advancing age (213, 530, > 730, and > 730 days for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively [Figure 1]). Among the treated patients, median (25, 75 percentile) time to treatment initiation was 63 (8, 257) days, with treatment initiation increasingly delayed with age. Of the treatments prescribed, 76% of patients were prescribed metformin, 19% sulphonylurea, 4% insulin, and 1% other. Metformin use decreased with age (77%, 82%, 76%, and 66%, for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively; p < 0.0001 for trend using chi-square test) and sulphonylurea use increased with age (15%, 15%, 22%, and 32%, respectively; p < 0.0001 for trend using chi-square test).
(Enlarge Image)
Figure 1.
Kaplan-Meier curves for time to initiation of antihyperglycaemic therapy after diagnosis of type 2 diabetes by age group.
Cox regression analysis adjusting for patients' baseline characteristics showed that increasing age was associated with longer time to initiation of antihyperglycaemic medication (Table 2). An HbA1c ≥ 7.5% at diagnosis was associated with shorter time to treatment initiation (Table 2). In this cohort of patients (i.e., HbA1c ≥ 7.5% at diagnosis, n = 2,446), 73%, 81%, and 87% initiated antihyperglycaemic therapy within 180 days, 1 year, and 2 years of diagnosis, respectively. There was a significant interaction between age and HbA1c at diagnosis such that the negative effect of age on treatment initiation was reduced in individuals with higher HbA1c values at diagnosis, i.e., ≥ 7.5% (Table 2). Other significant predictors associated with shorter time to antihyperglycaemic medication initiation included female gender, use of lipid-modifying agents, use of weight-reducing agents and later physician registration year. The missing indicator for HbA1c values was associated with shorter time to initiation (Table 2). During the follow-up period, development of cardiovascular conditions (Table 2), hospitalization, and new use of antihypertensive, lipid-modifying, gastroprotective, or weight-reducing agents were associated with shorter times to treatment initiation (Table 2).
Figure 2 illustrates that higher HbA1c values at the end of follow up were associated with lower levels of non-treatment with antihyperglycaemic medications. Within each HbA1c category there was a significant trend for patients in the older age groups to remain untreated (Figure 2). Among those untreated, the proportion of patients with an HbA1c ≥ 7.5% was not statistically different across age groups (p > 0.05).
(Enlarge Image)
Figure 2.
Proportion of patients untreated with antihyperglycaemic medication after the 2-year follow-up period by age group and last available HbA1c value.