1129-P: Association between the Intensity of Diabetes Therapy, Achieved HbA1c, and Persistence

Background: Comparative, real-world evidence for clinical outcomes of different glucose lowering pharmacotherapy regimens in diabetes is limited. We compared therapy persistence and achieved HbA1c amongst episodes of different pharmacotherapy regimens in a community-based Australian cohort.

Methods: The EXTEND45 Study combines baseline questionnaire responses (2006-2009) with data from community pathology providers, the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) (provided by the Department of Human Services) and other routinely collected health databases for participants of the 45 and Up study for the period 2005 to 2014. Linkage of MBS and PBS data was performed by the Sax Institute and all other data sources by the Centre for Health Record Linkage. We identified 24,236 people aged ≥45 years with diabetes. Using treatment episodes as our unit of analysis, the persistence and achieved glycaemic control of episodes was compared according to therapy regimens using Wilcoxon Sum rank tests.

Results: Among 149,532 episodes, mean (median) therapy persistence was 163 (76), 175 (84), 132 (54) and 164 (108) days for mono-, dual, multioral-, and insulin-based therapy episodes, respectively. For monotherapy episodes, mean persistence was greatest for metformin (178 days). For dual therapy, mean persistence was longest for combinations that did not involve metformin or a sulfonylurea (195 days). Mean HbA1c was 6.9%, 7.3%, 7.4% and 7.9% for mono-, dual, multioral-, and insulin-based therapy episodes, respectively. For monotherapy episodes, mean HbA1c was lowest for metformin (6.8%) whilst for dual therapy, mean persistence was highest for sulfonylurea combinations that did not involve metformin (7.5%).

Conclusion: Persistence with therapy is heterogeneous across different intensities of therapy and is shortest for multioral-agent regimens. Participants requiring insulin therapy have the highest achieved HbA1c, which is likely to reflect disease severity.