PMID- 25185770
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141218
LR  - 20211021
IS  - 1869-6953 (Print)
IS  - 1869-6961 (Electronic)
IS  - 1869-6961 (Linking)
VI  - 5
IP  - 2
DP  - 2014 Dec
TI  - Assessment of Unmet Clinical Need in Type 2 Diabetic Patients on Conventional 
      Therapy in the UK.
PG  - 567-78
LID - 10.1007/s13300-014-0079-6 [doi]
AB  - INTRODUCTION: Type 2 diabetes mellitus (T2DM) is an increasing problem worldwide 
      and a leading risk factor for cardiovascular disease. As beta cell function 
      declines, the management of T2DM typically comprises of escalations in treatment 
      from diet and exercise to oral therapies and eventually insulin. Treatment 
      algorithms based on the attainment of blood glucose targets may not account for 
      changes in other cardiovascular risk factors. The objective of this study is to 
      describe unmet clinical need, defined as failure to reduce weight or meet targets 
      for blood pressure, total cholesterol or glycated hemoglobin (HbA1c) levels. 
      METHODS: Anonymized UK patient data for those (1) initiating oral antidiabetic 
      drug (OAD) monotherapy, (2) escalating to dual therapy, (3) escalating to triple 
      therapy, and (4) escalating to insulin therapy over the study period 
      (01/01/2005-31/12/2009) were obtained from The Health Improvement Network (THIN). 
      Changes in risk factors were evaluated before and after therapy escalation, and 
      the attainment of targets, assessed at the last recorded measurement, as follows: 
      HbA1c <7.5%, systolic blood pressure (SBP) <140 mmHg, total cholesterol (TC) 
      <5 mmol/L, and reduction in weight. RESULTS: Prior to therapy escalation, mean 
      HbA1c in each subgroup exceeded 7.5% and was higher respective to the number of 
      OADs being used (monotherapy: 8.03%; double: 8.48%; triple: 8.71%). Insulin users 
      displayed the highest HbA1c prior to treatment escalation (9.78%). Following 
      escalation, a decline in HbA1c was observed in all subgroups. By contrast, mean 
      SBP and TC levels decreased prior to the addition of a second and third oral 
      therapy. Consistent improvements following treatment escalation were not observed 
      across the other risk factors following therapy escalation. Overall, the 
      proportion of subjects that attained all four targets ranged from 3% (monotherapy 
      and insulin) to 6% (dual therapy). CONCLUSION: The potential unmet clinical need 
      among conventionally treated T2DM patients is significant, with respect to the 
      control of blood glucose and other cardiovascular risk factors: SBP, TC, and 
      weight. There clearly remains the need for new therapeutic approaches to 
      alleviate the burden associated with T2DM.
FAU - Bennett, Hayley
AU  - Bennett H
AD  - Health Economics and Outcomes Research Ltd, Singleton Court Business Park, 
      Wonastow Rd, Monmouth, NP25 5JA, UK, hayley.bennettwilton@heor.co.uk.
FAU - McEwan, Phil
AU  - McEwan P
FAU - Bergenheim, Klas
AU  - Bergenheim K
FAU - Gordon, Jason
AU  - Gordon J
LA  - eng
PT  - Journal Article
DEP - 20140904
PL  - United States
TA  - Diabetes Ther
JT  - Diabetes therapy : research, treatment and education of diabetes and related 
      disorders
JID - 101539025
PMC - PMC4269656
EDAT- 2014/09/05 06:00
MHDA- 2014/09/05 06:01
PMCR- 2014/09/04
CRDT- 2014/09/05 06:00
PHST- 2014/05/16 00:00 [received]
PHST- 2014/09/05 06:00 [entrez]
PHST- 2014/09/05 06:00 [pubmed]
PHST- 2014/09/05 06:01 [medline]
PHST- 2014/09/04 00:00 [pmc-release]
AID - 79 [pii]
AID - 10.1007/s13300-014-0079-6 [doi]
PST - ppublish
SO  - Diabetes Ther. 2014 Dec;5(2):567-78. doi: 10.1007/s13300-014-0079-6. Epub 2014 
      Sep 4.