Introduction: There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined secular trends in GLDs utilization, glycemic control and rate of SH among people with diabetes, mainly type 2 diabetes, in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000.
Methods: Using population-based data from the Hong Kong Diabetes Surveillance Database consisting mainly of Chinese living a westernized lifestyle, we estimated the annual age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged ≥20 years between 2002-2016. We used Joinpoint regression to examine secular trends over time.
Results: In 2002-2016, use declined for sulfonylureas (50.7% to 28.9%) but increased for metformin (47.8% to 57.3%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 7.0%). The proportion of patients with HbA1c of 6.0-7.0% increased from 25.6% to 37.2% while the rate of SH declined from 4.4 to 1.7 per 100 person-years. The main improvement in annual mean HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.8 (1.6)% to 7.4 (1.7)% (p<0·001). The 20-44 age group had the highest proportion of HbA1c>9% with rising proportions not treated with any GLDs (from 4.3% to 10.5%).
Conclusion: Prescription of GLDs has changed dramatically in Hong Kong in the past 15 years in line with treatment guidelines and introduction of new drugs. The modest but important improvement in HbA1c since 2007 coincided with widening reform of diabetes services in primary care and introduction of DPP-4i. Poor glycemic control and low utilization of GLDs in the youngest age group calls for targeted treatment strategies and ongoing surveillance.
A. Yang: None. H. Wu: None. E.S. Lau: None. R.C. Ma: Advisory Panel; Self; AstraZeneca. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Tricida Inc. A.P. Kong: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Abbott, AstraZeneca, Sanofi. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. W. So: None. A. Luk: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Roche Pharma. Other Relationship; Self; Merck Sharp & Dohme Corp. J.C. Chan: None. E. Chow: None.
Chinese University of Hong Kong