Prescribing practices and clinical predictors of glucose-lowering therapy within the first year in people with newly diagnosed Type 2 diabetes

TY - JOUR

T1 - Prescribing practices and clinical predictors of glucose-lowering therapy within the first year in people with newly diagnosed Type 2 diabetes

AU - Mor, A

AU - Berencsi, K

AU - Svensson, E

AU - Rungby, J

AU - Nielsen, J S

AU - Friborg, S

AU - Brandslund, I

AU - Christiansen, J S

AU - Vaag, A

AU - Beck-Nielsen, H

AU - Sørensen, H T

AU - Thomsen, R W

N1 - © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Aim: To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. Methods: We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). Results: Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62%) received monotherapy [685 (95%) with metformin], and 133 (12%) received more than one drug. Predictors of receiving any vs. no therapy and combination vs. monotherapy were: age < 40 years [RR: 1.29 (95% CI: 1.16-1.44) and 3.60 (95% CI: 2.36-5.50)]; high Charlson Comorbidity Index [RRs: 1.20 (95% CI: 1.05-1.38) and 2.08 (95% CI: 1.16-3.72)]; central obesity [RRs: 1.23 (95% CI: 1.04-1.44) and 1.93 (95% CI: 0.76-4.94)]; fasting blood glucose of ≥ 7.5 mmol/l [RRs: 1.25 (95% CI: 1.10-1.42) and 1.94 (95% CI: 1.02-3.71)]; and HbA1c ≥ 59 mmol/mol (≥ 7.5%) [RR: 1.26 (95% CI: 1.20-1.32) and 2.86 (95% CI: 1.97-4.14)]. Weight gain ≥ 30 kg since age 20, lack of physical exercise and C-peptide of < 300 pmol/l also predicted therapy. Conclusions: Comorbidity, young age, central obesity and poor baseline glycaemic control are important predictors of therapy one year after Type 2 diabetes mellitus debut. What's new?: This nationwide prospective cohort study describes real-life prescribing practices and predictors of glucose-lowering therapy within the first year following Type 2 diabetes mellitus diagnosis in Denmark. Within one year after diabetes debut, 74% of patients were on a glucose-lowering drug, and 12% received combination therapy. Presence of comorbidity, young age, central obesity and poor baseline glucose control were important predictors, both of receiving any glucose-lowering therapy and of receiving combination therapy.

AB - Aim: To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. Methods: We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). Results: Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62%) received monotherapy [685 (95%) with metformin], and 133 (12%) received more than one drug. Predictors of receiving any vs. no therapy and combination vs. monotherapy were: age < 40 years [RR: 1.29 (95% CI: 1.16-1.44) and 3.60 (95% CI: 2.36-5.50)]; high Charlson Comorbidity Index [RRs: 1.20 (95% CI: 1.05-1.38) and 2.08 (95% CI: 1.16-3.72)]; central obesity [RRs: 1.23 (95% CI: 1.04-1.44) and 1.93 (95% CI: 0.76-4.94)]; fasting blood glucose of ≥ 7.5 mmol/l [RRs: 1.25 (95% CI: 1.10-1.42) and 1.94 (95% CI: 1.02-3.71)]; and HbA1c ≥ 59 mmol/mol (≥ 7.5%) [RR: 1.26 (95% CI: 1.20-1.32) and 2.86 (95% CI: 1.97-4.14)]. Weight gain ≥ 30 kg since age 20, lack of physical exercise and C-peptide of < 300 pmol/l also predicted therapy. Conclusions: Comorbidity, young age, central obesity and poor baseline glycaemic control are important predictors of therapy one year after Type 2 diabetes mellitus debut. What's new?: This nationwide prospective cohort study describes real-life prescribing practices and predictors of glucose-lowering therapy within the first year following Type 2 diabetes mellitus diagnosis in Denmark. Within one year after diabetes debut, 74% of patients were on a glucose-lowering drug, and 12% received combination therapy. Presence of comorbidity, young age, central obesity and poor baseline glucose control were important predictors, both of receiving any glucose-lowering therapy and of receiving combination therapy.

U2 - 10.1111/dme.12819

DO - 10.1111/dme.12819

M3 - Journal article

C2 - 26032247

SN - 0742-3071

VL - 32

SP - 1546

EP - 1554

JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 12

ER -