dc.contributor.author | McGovern, A | |
dc.contributor.author | Shields, B | |
dc.contributor.author | Hattersley, A | |
dc.contributor.author | Pearson, E | |
dc.contributor.author | Jones, AG | |
dc.contributor.author | Dennis, JM | |
dc.date.accessioned | 2019-03-13T10:55:20Z | |
dc.date.issued | 2019-04-12 | |
dc.description.abstract | Background: It is unclear what to do when people with type 2 diabetes have had no or a
limited glycemic response to a recently introduced medication. Intra-individual HbA1c
variability can obscure true response. Some guidelines suggest stopping apparently
ineffective therapy, but no studies have addressed this issue.
Methods: In a retrospective cohort analysis using the UK Clinical Practice Research Datalink
(CPRD), we assessed the outcome of 55,530 patients with type 2 diabetes starting their
second or third non-insulin glucose lowering medication, with a baseline HbA1c >58mmol/mol
(7.5%). For those with no HbA1c improvement or a limited response at 6 months (HbA1c fall
<5.5mmol/mol [0.5%]) we compared HbA1c 12 months later in those who continued their
treatment unchanged, switched to new treatment, or added new treatment.
Results: An increase or a limited reduction in HbA1c was common, occurring in 21.9%
(12,168/55,230), who had a mean HbA1c increase of 2.5mmol/mol (0.2%). After this limited
response, continuing therapy was more frequent (n=9,308; 74%) than switching (n=1,177; 9%)
or adding (n=2,163; 17%). Twelve months later, in those who switched medication HbA1c fell
(-6.8mmol/mol [-0.6%], 95%CI -7.7, -6.0) only slightly more than those who continued
unchanged (-5.1 mmol/mol [-0.5%], 95%CI -5.5, -4.8). Adding another new therapy was
associated with a substantially better reduction (-12.4mmol/mol [-1.1%], 95%CI -13.1, -11.7).
Propensity score matched subgroups demonstrated similar results.
Conclusions: Where glucose lowering therapy does not appear effective on initial HbA1c
testing, changing agents does not improve glycemic control. The initial agent should be
continued with another therapy added. | en_GB |
dc.description.sponsorship | Medical Research Council (MRC) | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.identifier.citation | Vol. 17 (79). Published online 12 April 2019. | en_GB |
dc.identifier.doi | 10.1186/s12916-019-1307-8 | |
dc.identifier.grantnumber | MR/N00633X/1 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/36432 | |
dc.language.iso | en | en_GB |
dc.publisher | BioMed Central | en_GB |
dc.rights | © The Author(s), 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated | |
dc.subject | Type 2 diabetes | en_GB |
dc.subject | oral glucose lowering medication | en_GB |
dc.subject | HbA1c | en_GB |
dc.subject | addition | en_GB |
dc.subject | switching | en_GB |
dc.subject | continuation | en_GB |
dc.subject | glycaemic control | en_GB |
dc.title | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-03-13T10:55:20Z | |
dc.identifier.issn | 1741-7015 | |
dc.description | This is the author accepted manuscript. The final version is available from BioMed Central via the DOI in this record. | en_GB |
dc.identifier.journal | BMC Medicine | en_GB |
dc.rights.uri | http://www.rioxx.net/licenses/all-rights-reserved | en_GB |
dcterms.dateAccepted | 2019-03-05 | |
exeter.funder | ::Medical Research Council (MRC) | en_GB |
exeter.funder | ::National Institute for Health Research (NIHR) | en_GB |
rioxxterms.version | AM | en_GB |
rioxxterms.licenseref.startdate | 2019-03-05 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-03-13T10:26:14Z | |
refterms.versionFCD | AM | |
refterms.dateFOA | 2019-05-10T15:24:22Z | |
refterms.panel | A | en_GB |