Diabetes management and treatment approaches outside of North America and West Europe in 2006 and 2015
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The impact of introducing new classes of glucose-lowering medication (GLM) on diabetes management remains unclear, especially outside North America and Western Europe. Therefore, we aimed to analyse trends in glycaemic control and the usage of new and old GLMs in people with type 2 diabetes from 2006 to 2015.
Summary data from clinical services from nine countries outside North America and Western Europe were collected and pooled for statistical analysis. Each site summarized individual-level data from out-patient medical records for 2006 and 2015. Data included: demographics; HbA1c and fasting plasma glucose levels; and the proportions of patients taking GLM as monotherapy, combination therapy and/or insulin.
Between 2006 and 2015, glycaemic control remained stable, although body mass index and duration of diabetes increased in most sites. The proportion of people on GLM increased, and the therapeutic regimens became more complex. There were increases in the use of insulin and triple therapy in most sites, while monotherapy, particularly in relation to sulphonylureas, decreased. Despite the introduction of new GLMs, such as DPP-4 inhibitors, insulin use increased over time.
There was no clear evidence that the use of new classes of GLMs was associated with improvements in glycaemic control or reduced the reliance on insulin. These findings were consistent across a range of economic and geographic settings.
KeywordsDiabetes mellitus Glycated haemoglobin Disease management Therapeutics Hypoglycaemic agents
This study is funded by AstraZeneca. MT is supported by a Monash University Postgraduate Research Scholarship and a Baker IDI Bright Sparks Scholarship, Australia. JES and DJM are supported by National Health and Medical Research Council Senior Research Fellowships, Australia. This work is partially supported by the Victorian OIS program.
Compliance with ethical standards
Conflict of interest
This study was supported by AstraZeneca.
Human and animal rights disclosure
The study was approved by the Monash University Human Research Ethics Committee (number 1441), and the Alfred Ethics Committee (number 64/15) in Australia and in some of the sites, as required by local guidelines.
For this type of study, informed consent is not required.
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