Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study
Background: Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence. Methods: We performed an episode-based analysis of the EXTEN...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Endocrine and Metabolic Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666396123000122 |
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| author | Tamara K. Young Carinna Hockham Louisa Sukkar Amy Kang Min Jun Celine Foote Jannah Baker Kris Rogers Sophia Zoungas Alan Cass David Sullivan Meg J. Jardine |
| author_facet | Tamara K. Young Carinna Hockham Louisa Sukkar Amy Kang Min Jun Celine Foote Jannah Baker Kris Rogers Sophia Zoungas Alan Cass David Sullivan Meg J. Jardine |
| author_sort | Tamara K. Young |
| collection | DOAJ |
| description | Background: Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence. Methods: We performed an episode-based analysis of the EXTEND-45 dataset, assessing trends in glucose lowering therapy and the associated outcomes of HbA1c and treatment persistence. Trends from 2009 to 2014 were assessed for each intensity level of a glucose lowering therapy regimen, according to the year prescribed. Episodes were defined as the length of time that an individual adhered to a regimen through ongoing prescription, and this was used as to define persistence. Mean HbA1c were calculated for each episode. Persistence and HbA1c were compared across the different regimens of treatment intensity. Results: The intensity of glucose lowering therapy remained stable over time with around one third of episodes utilising a single glucose lowering agent. Mean HbA1c was higher for insulin-based treatment (mean 7.9 % SD = 1.3 %), and lowest for episodes of no glucose lowering treatment (mean 6.3 % (SD = 0.8 %). Around half of participants achieved glycemic targets of 7 %. While there was considerable variation in persistence, the median persistence was around 3 months (94 days, IQR 51–201 days). Conclusions: Therapeutic intensity for diabetes has remained stable over 9 years. Whilst there was considerable variability in persistence with glucose lowering regimens, the mean duration of all regimens was less than a year. Requirement for higher intensity treatment with insulin was related to poorer glycemic control. |
| first_indexed | 2024-03-12T13:19:42Z |
| format | Article |
| id | doaj.art-b7e41bc66102417182393d26f375322e |
| institution | Directory Open Access Journal |
| issn | 2666-3961 |
| language | English |
| last_indexed | 2024-03-12T13:19:42Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Endocrine and Metabolic Science |
| spelling | doaj.art-b7e41bc66102417182393d26f375322e2023-08-26T04:44:14ZengElsevierEndocrine and Metabolic Science2666-39612023-09-0112100135Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort StudyTamara K. Young0Carinna Hockham1Louisa Sukkar2Amy Kang3Min Jun4Celine Foote5Jannah Baker6Kris Rogers7Sophia Zoungas8Alan Cass9David Sullivan10Meg J. Jardine11The George Institute for Global Health, UNSW, Sydney, Australia; Corresponding author.The George Institute for Global Health, Imperial College London, United KingdomThe George Institute for Global Health, UNSW, Sydney, AustraliaThe George Institute for Global Health, UNSW, Sydney, Australia; Prince of Wales Hospital, Randwick, AustraliaThe George Institute for Global Health, UNSW, Sydney, AustraliaThe George Institute for Global Health, UNSW, Sydney, Australia; Concord Hospital, Sydney, AustraliaUniversity of Sydney, AustraliaThe George Institute for Global Health, UNSW, Sydney, Australia; University of Technology, Sydney, AustraliaMonash University, Melbourne, AustraliaMenzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaSchool of Public Health, University of Sydney, AustraliaThe George Institute for Global Health, UNSW, Sydney, Australia; Concord Hospital, Sydney, Australia; NHMRC Clinical Trial Centre, University of Sydney, Sydney, AustraliaBackground: Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence. Methods: We performed an episode-based analysis of the EXTEND-45 dataset, assessing trends in glucose lowering therapy and the associated outcomes of HbA1c and treatment persistence. Trends from 2009 to 2014 were assessed for each intensity level of a glucose lowering therapy regimen, according to the year prescribed. Episodes were defined as the length of time that an individual adhered to a regimen through ongoing prescription, and this was used as to define persistence. Mean HbA1c were calculated for each episode. Persistence and HbA1c were compared across the different regimens of treatment intensity. Results: The intensity of glucose lowering therapy remained stable over time with around one third of episodes utilising a single glucose lowering agent. Mean HbA1c was higher for insulin-based treatment (mean 7.9 % SD = 1.3 %), and lowest for episodes of no glucose lowering treatment (mean 6.3 % (SD = 0.8 %). Around half of participants achieved glycemic targets of 7 %. While there was considerable variation in persistence, the median persistence was around 3 months (94 days, IQR 51–201 days). Conclusions: Therapeutic intensity for diabetes has remained stable over 9 years. Whilst there was considerable variability in persistence with glucose lowering regimens, the mean duration of all regimens was less than a year. Requirement for higher intensity treatment with insulin was related to poorer glycemic control.http://www.sciencedirect.com/science/article/pii/S2666396123000122Diabetes mellitusPharmacotherapyPersistenceHbA1c |
| spellingShingle | Tamara K. Young Carinna Hockham Louisa Sukkar Amy Kang Min Jun Celine Foote Jannah Baker Kris Rogers Sophia Zoungas Alan Cass David Sullivan Meg J. Jardine Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study Endocrine and Metabolic Science Diabetes mellitus Pharmacotherapy Persistence HbA1c |
| title | Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study |
| title_full | Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study |
| title_fullStr | Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study |
| title_full_unstemmed | Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study |
| title_short | Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study |
| title_sort | duration and effectiveness of glucose lowering regimens in the real world management of diabetes data from the australian extend45 linked cohort study |
| topic | Diabetes mellitus Pharmacotherapy Persistence HbA1c |
| url | http://www.sciencedirect.com/science/article/pii/S2666396123000122 |
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