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Early treatment switch may improve glycemic control in type 2 diabetes
In patients with type 2 diabetes, switching treatment within 90 days of identifying HbA1c of 9% or more appears to yield improved short-term glycemic control but higher cost, according to recent findings.
“Following evidence of suboptimal glycemic control (HbA1c ≥ 9%), less than half (35%) of patients had evidence of a treatment revision within 90 days. This early treatment revision was associated with a greater average decrease in HbA1c at 6 to 12 months following the original suboptimal HbA1c result even after controlling for baseline patient characteristics,” Phil Schwab, PhD, of Comprehensive Health Insights Inc., a Humana Company in Louisville, Kentucky, told Endocrine Today.
Schwab and colleagues evaluated member enrollment, medical and pharmacy claims and laboratory results from a large national health plan on 8,463 patients with type 2 diabetes and an HbA1c of at least 9% (mean HbA1c, 10.2%) between 2008 and 2009. Participants were stratified into two groups: early treatment revision (within 90 days of index date; n = 2,673) and delayed treatment revision (n = 5,790).
Phil Schwab
The researchers found that mean time to treatment revision was 532 days throughout the whole sample. Revision was made to the treatment regimens of 34.7% of participants within 90 days of laboratory-confirmed HbA1c of 9% or more.
The mean HbA1c change for the early treatment group was –2.1% compared with –1.5% for the delayed treatment group (P < .0001). A regression model controlling for potential baseline confounders revealed that treatment revision was correlated with an HbA1c reduction of 2.1% in the early treatment group vs. 1.87% in the delayed treatment group (P < .001). Total health care costs, medical costs and pharmacy costs were higher for the early treatment group compared with the delayed treatment group after 12, 24 and 36 months (P < .05 for all).
“These real-world observations highlight that patients may not receive adequate treatment revisions despite evidence of suboptimal glycemic control (HbA1c ≥ 9%) even though treatment revision may decrease HbA1c,” Schwab said. – by Jennifer Byrne
For more information:
Phil Schwab, PhD, can be reached at pschwab@humana.com.
Disclosure: Schwab reports being a shareholder of Humana Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.