A significant proportion of patients with type 2 diabetes (T2DM) have suboptimal glycemic control which is associated with an increased risk of long-term complications. Clinical guidelines have recommended the use of initial combination therapy, rather than metformin monotherapy, in patients with high HbA1c (≥9%) at diagnosis. However, the adherence to these guideline recommendations and the impact of use of early combination therapy on glycemic goal attainment in the real world is not well known. We conducted a retrospective study using the U.S. Optum Research Database (2010-2015). The study population included T2DM patients aged ≥18 years with a baseline HbA1c of ≥9%. Index date was defined as the first prescription for an antidiabetic agent. Combination therapy was defined as receiving 2 or more antidiabetic classes within 1 month of the index date. During the 2-year follow-up period following the index date, we also compared time to goal attainment (HbA1c of <7%) among patients receiving initial monotherapy vs. initial combination therapy. A total of 13,791 T2DM patients met the inclusion criteria; 34.8% females; mean age: 54 years. Overall 41.4% were initiated on a combination therapy and 58.6% initiated on monotherapy. Patients receiving either treatment were generally similar. Patients receiving combination therapy had a lower mean age (53.0 vs. 54.7), had a higher mean total cholesterol (213 vs. 208 mg/dL) and higher triglyceride (319 vs. 282 mg/dL). The median time to goal attainment was shorter among those on combination therapy vs. monotherapy (318 vs. 372 days). Our study suggests that less than half of newly diagnosed U.S. patients with high HbA1c receive initial combination therapy. Furthermore, those receiving initial combination therapy achieve glycemic goal earlier than patients receiving monotherapy.
R.M. Klok: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. T. Gulati: Consultant; Self; Merck & Co., Inc. S. Rajpathak: None. S. Pal: Consultant; Self; Merck & Co., Inc. L. Yang: Employee; Self; Bristol-Myers Squibb Company, Merck & Co., Inc. A. Bandyopadhyay: Consultant; Self; Merck & Co., Inc. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited.
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