In the past 20 years, significant updates in diabetes management guidelines were performed. In this study we aimed to evaluate long-term trends in the treatment initiation and management of type 2 diabetes mellitus (T2DM). In this retrospective study, a computerized clinical database from Maccabi Healthcare Services, a 2.3 million member in Israel, was used. Included were adults T2DM patients who initiated antihyperglycemic medication between 1999 and 2018 (N=153,168). Fasting plasma glucose (FPG) and HbA1c levels were evaluated at treatment initiation and after 6, 12 and 24 months. In addition, first and second line treatment regimen were examined. Over twenty years of observation, FPG at therapy initiation decreased from 167.3±68.7 mg/dl (mean±SD) in 1999-2002 to 136.1±53.6 mg/dl in 2015-2018 (Figure). The respective decrement in HbA1c was from 7.8±2.1% to 6.8±1.8%. There was a tremendous difference in treatment regimen: In 1999-2002, metformin and sulfonylurea were the leading first line medications (63.5% and 37.0%, respectively) while in 2015-2018, the leading first line medications were metformin and DPP-4i (94.2% and 9.9% of patients, respectively). Study result indicate a clear trend of initiating antidiabetic treatment at lower FPG and HbA1c levels, and the fast disappearance of sulfonylurea from the clinical practice.


C. Melzer Cohen: None. V. Shalev: None. G. Chodick: None.

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