This article is more than 5 years old. Information may no longer be current.
Early intervention after metformin failure improves HbA1c goal attainment
Click Here to Manage Email Alerts
Adults with type 2 diabetes who intensify therapy early after metformin monotherapy failure are more likely to reach established HbA1c goals vs. those who delay treatment intensification, according to recent findings.
“The results of our study demonstrate that a substantial number of patients with newly diagnosed type 2 diabetes fail to undergo intensification of therapy within 6 months of metformin monotherapy failure, a concerning finding given that the study also found that an early intervention (within 6 months) in patients who fail metformin monotherapy resulted in a more rapid attainment of A1C goals,” Kevin M. Pantalone, DO, an endocrinologist at Cleveland Clinic, told Endocrine Today. “After patients are initiated on a regimen of metformin and lifestyle modification, we should be checking the HbA1c within 3 months and intensifying therapy in those who are still not at goal (generally an HbA1c < 7%).”
Pantalone and colleagues analyzed the electronic health records of 5,239 patients with newly diagnosed type 2 diabetes at Cleveland Clinic between 2005 and 2013 who did not reach their target HbA1c goal after at least 3 months of first-line metformin monotherapy (45% men; mean age, 58 years; 77% white; 46% never-smokers). The first HbA1c measurement after 3 months of metformin therapy served as the baseline HbA1c for this study; patients were stratified by baseline HbA1c (> 7%, n = 1,168; > 7.5%, n = 679; > 8%, n = 429). Researchers used a time-dependent Cox regression analysis to compare the time until HbA1c goal attainment in patients who received early intensification of therapy (within 6 months of metformin failure) vs. late intensification. The analysis was performed for HbA1c goals of 7% (n = 1,168), 7.5% (n = 679), and 8% (n = 429).
Researchers found that treatment was intensified early in 62% of patients not meeting a defined HbA1c goal of 7%; in 69% of patients not meeting an HbA1c goal of 7.5% and in 72% of patients not meeting an HbA1c goal of 8%; probability of undergoing an early intensification was greater the higher the HbA1c category.
Researchers found that, regardless of the HbA1c goal, attainment of that goal was shorter among those who received early intensification of therapy (P < .05 for all). Across the three HbA1c categories, those who underwent early intervention had a lower probability of not having their HbA1c under control (initial HbA1c > 7%: HR = 0.57; 95% CI, 0.22-0.91; initial HbA1c > 7.5%: HR = 0.25; 95% CI, 0.05-0.44; initial HbA1c > 8%: HR = 0.25; 95% CI, 0-0.49).
“What remains to be seen is if these early and aggressive interventions actually translate into improvements in clinical outcomes, not just an HbA1c goal attainment,” Pantalone said. “This will be the topic of future research.” – by Regina Schaffer
Disclosure: Merck sponsored this study. Pantalone reports receiving research funding through Novo Nordisk and Merck; consulting fees from Eli Lilly, Merck, Novo Nordisk and Sanofi; and honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Merck, Novo Nordisk and Sanofi for speaking or educational activities. Please see the full study for the other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts