NICE guidelines suggest premix as a treatment option for people with T2D with HbA1c ≥9 % uncontrolled by ≥2 oral antidiabetic drugs (OADs). This retrospective cohort study explored real-world evidence for glycemic control with premix. UK electronic medical record data from THIN database were captured for adults with T2D uncontrolled (HbA1c ≥9 %) on ≥2 OADs initiating premix (index date) from 1/1/2010 to 12/31/2016. Baseline data were collected 12 months pre-index and outcomes followed for 24 months. Glycemic control was assessed by time to first achievement of HbA1c target <7.5 % and change in HbA1c over time, and evaluated by baseline characteristics. The final cohort had 974 participants (mean age 62 years; 56% male; mean BMI 31 kg/m2; 27% overweight; 44% obese; 8% Class III obese; mean HbA1c 11.3 %). Common comorbidities were hypertension (64%), dyslipidemia (23%) and nephropathy (21%). Background medication included metformin (99%), DPP-4i (51%), TZD (42%), SU (19%) and SGLT2i (0.5%). Probability of first achievement of HbA1c target <7.5 % was highest at 3-6 months (18%), 14% at 6-9 months, 15% at 9-12 months, and lower from 12 to 24 months (Figure). Target achievement differed by baseline HbA1c, but not OAD use. Probability of achieving glycemic targets on premix at 6 months was low, with little additional clinical benefit beyond 12 months, suggesting a high unmet need for early and timely therapy intensification.

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Disclosure

E.B. Jude: Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc., Sanofi. Other Relationship; Self; Lilly Diabetes, Menarini Group. A. Ali: Advisory Panel; Self; Eli Lilly and Company, Napp Pharmaceuticals, Novo Nordisk A/S, Sanofi. Research Support; Self; Eli Lilly and Company, Gelesis. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Stock/Shareholder; Self; Amarin Corporation. R. Emral: Advisory Panel; Self; Lilly Diabetes, Merck Sharp & Dohme Corp. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc., Sanofi-Aventis. N. Nanda: Advisory Panel; Self; Novartis AG. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc., Pfizer Inc., Sanofi. R. Lubwama: Employee; Self; Sanofi US. K.D. Palmer: Employee; Self; Sanofi. A. Shaunik: None. P. Raskin: None. F. Gomez-Peralta: Advisory Panel; Self; Abbott, Menarini Group, Novartis AG, Sanofi. Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novartis AG, Novo Nordisk A/S, Sanofi. C. Trescoli: None.

Funding

Sanofi

© 2020 by the American Diabetes Association
2020
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