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24-08-2016 | Diabetes | News | Article

Prompt action urged after metformin failure for newly diagnosed diabetes

medwireNews: A large study shows frequent long delays in the intensification of antidiabetic therapy in newly diagnosed patients who fail to achieve glycaemic control with metformin.

Moreover, patients who received delayed intervention had a reduced likelihood of achieving glycaemic control during follow-up.

The findings, in 5239 patients newly diagnosed with Type 2 diabetes, are similar to those reported for patients with established diabetes, say Kevin Pantalone (Cleveland Clinic, Ohio, USA) and co-researchers.

“Patients with type 2 diabetes are often highly motivated near the time of diagnosis, so it would seem important to leverage this motivation and intervene to improve glycemic control early on in the disease process and not allow for time to pass and perhaps risk losing the patient to follow-up”, they say.

However, they note that, even in this population, the patients themselves may often contribute to this treatment inertia. When they reviewed the records of 20 randomly selected patients who had not undergone timely treatment intensification, they found that nine cases were caused purely by lack of action from the physician, but 11 had multiple indicators of “patient inertia”, such as missed appointments and poor treatment adherence.

Monotherapy failure was defined as having elevated glycated haemoglobin (HbA1c) levels after 3 months of metformin treatment, as per current guidelines, and the team defined timely treatment intensification as within 6 months (ie, an additional 3 months), despite guidelines advising immediate action, to avoid “an overestimation of the problem”.

The likelihood of timely treatment intensification increased with higher 3-month HbA1c level, with early intensification occurring in 62%, 69% and 72% of those with levels of greater than 7% but no more than 7.5%, greater than 7.5% but no more than 8%, and higher than 8%, respectively. Higher HbA1c level also increased the likelihood of patients receiving an additional antidiabetic medication, rather than a metformin dose adjustment.

Irrespective of patients’ initial HbA1c level, treatment intensification within 6 months was associated with a significantly reduced likelihood of having uncontrolled levels at all points during up to 4.5 years of follow-up.

“Thus, failure to intervene early, when it is indicated, may have a lasting effect on the ability to attain glycemic control”, write the researchers in Diabetes Care.

“This is a worrisome finding, because glycemic control early in the course of disease has ‘a legacy effect’ on the development of future diabetes-related complications.”

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016

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