PMID- 26277380
OWN - NLM
STAT- MEDLINE
DCOM- 20160627
LR  - 20220330
IS  - 1432-0428 (Electronic)
IS  - 0012-186X (Linking)
VI  - 58
IP  - 10
DP  - 2015 Oct
TI  - Early glycaemic control in metformin users receiving their first add-on therapy: 
      a population-based study of 4,734 people with type 2 diabetes.
PG  - 2247-53
LID - 10.1007/s00125-015-3698-1 [doi]
AB  - AIMS/HYPOTHESIS: The aims of this work were to assess glycaemic control in 
      metformin users receiving their first add-on glucose-lowering therapy and to 
      examine the real-life effectiveness of different add-on drugs. METHODS: We 
      carried out a population-based cohort study using healthcare databases in 
      northern Denmark during 2000-2012. We included 4,734 persons who initiated 
      metformin monotherapy and added another glucose-lowering drug within 3 years. 
      Attainment of recommended HbA1c goals within 6 months of add-on was investigated, 
      using Poisson regression analysis adjusted for age, sex, baseline HbA(1c), 
      diabetes duration, complications and Charlson Comorbidity Index. RESULTS: Median 
      metformin treatment duration at intensification was 12 months (interquartile 
      range [IQR] 4-23 months) and pre-intensification HbA(1c) was 8.0% (IQR 7.2-9.2%) 
      (64 [IQR 55-77] mmol/mol). Median HbA(1c) dropped 1.2% (13 mmol/mol) with a 
      sulfonylurea (SU) add-on, 0.8% (9 mmol/mol) with a dipeptidyl peptidase-4 (DPP-4) 
      inhibitor, 1.3% (14 mmol/mol) with a glucagon-like peptide-1 (GLP-1) receptor 
      agonist, 0.9% (10 mmol/mol) with other non-insulin drugs and 2.4% (26 mmol/mol) 
      with insulin. Compared with SU add-on, attainment of HbA(1c) <7% (<53 mmol/mol) 
      was higher with GLP-1 receptor agonists (adjusted RR [aRR] 1.10; 95% CI 1.01, 
      1.19) and lower with DPP-4 inhibitors (aRR 0.94; 95% CI 0.89, 0.99), other drugs 
      (aRR 0.86; 95% CI 0.77, 0.96) and insulin (aRR 0.88; 95% CI 0.77, 0.99). The 
      proportion of metformin add-on users who attained HbA(1c) <7% (<53 mmol/mol) 
      increased from 46% in 2000-2003 to 59% in 2010-2012, whereas attainment of 
      HbA(1c) <6.5% (<48 mmol/mol) remained 30% among patients aged <65 years without 
      comorbidities. CONCLUSIONS/INTERPRETATION: Among early type 2 diabetes patients 
      receiving their first metformin add-on treatment, HbA(1c) reduction with 
      different non-insulin drugs is similar to, and comparable with, that observed in 
      randomised trials, yet 41% do not achieve HbA(1c) <7% (<53 mmol/mol) within 6 
      months.
FAU - Thomsen, Reimar W
AU  - Thomsen RW
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark. 
      rwt@clin.au.dk.
FAU - Baggesen, Lisbeth M
AU  - Baggesen LM
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
FAU - Sogaard, Mette
AU  - Sogaard M
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
FAU - Pedersen, Lars
AU  - Pedersen L
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
FAU - Norrelund, Helene
AU  - Norrelund H
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
FAU - Buhl, Esben S
AU  - Buhl ES
AD  - Novo Nordisk Scandinavia AB, Orestad, Copenhagen, Denmark.
FAU - Haase, Christiane L
AU  - Haase CL
AD  - Novo Nordisk Scandinavia AB, Orestad, Copenhagen, Denmark.
FAU - Johnsen, Soren P
AU  - Johnsen SP
AD  - Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus 
      University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150816
PL  - Germany
TA  - Diabetologia
JT  - Diabetologia
JID - 0006777
RN  - 0 (Blood Glucose)
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Sulfonylurea Compounds)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Glucose/*analysis
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Male
MH  - Metformin/*therapeutic use
MH  - Middle Aged
MH  - Sulfonylurea Compounds/*therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Antidiabetic agents
OT  - Clinical quality
OT  - Comparative effectiveness
OT  - Glucose-lowering therapy
OT  - Glycaemic control
OT  - HbA1c
OT  - Hypoglycaemic agents
OT  - Metformin
OT  - Pharmacoepidemiology
OT  - Type 2 diabetes
EDAT- 2015/08/19 06:00
MHDA- 2016/06/28 06:00
CRDT- 2015/08/17 06:00
PHST- 2015/04/27 00:00 [received]
PHST- 2015/06/26 00:00 [accepted]
PHST- 2015/08/17 06:00 [entrez]
PHST- 2015/08/19 06:00 [pubmed]
PHST- 2016/06/28 06:00 [medline]
AID - 10.1007/s00125-015-3698-1 [pii]
AID - 10.1007/s00125-015-3698-1 [doi]
PST - ppublish
SO  - Diabetologia. 2015 Oct;58(10):2247-53. doi: 10.1007/s00125-015-3698-1. Epub 2015 
      Aug 16.