Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment.

AIMS: To determine the patterns and predictors of treatment intensification in patients with type 2 diabetes on ≥2 non-insulin antidiabetic drugs (NIADs) and inadequate glycaemic control in primary care in Catalonia, Spain. MATERIAL AND METHODS: This was a retrospective analysis using electronic medical records from patients with HbA1c ≥ 7% and a first prescription for a new NIAD or insulin recorded from January 2010 to December 2014. Therapeutic inertia was defined as no intensification if HbA1c was ≥8% at baseline or during follow-up. Time to first intensification was evaluated by time-to-event analysis, and factors predicting intensification through a competing-risk regression model. RESULTS: Among 23 678 patients with HbA1c ≥ 7%, 26.2% were censored without treatment intensification after a median follow up of 4.2 years. Among the 12 730 patients in the subgroup with HbA1c ≥ 8% at baseline or during follow-up, therapeutic inertia was present in 18.1% of cases. In the overall cohort, mean HbA1c at initiation of insulin and NIAD were 9.4% ± 1.5% and 8.7% ± 1.3%, respectively. Median time to first intensification was 17.1 months in patients with HbA1c 8.0% to 9.9%, and 10.1 months in those with HbA1c > 10%. Variables strongly associated with intensification were HbA1c values 8.0% to 9.9% (subhazard ratio [SHR], 1.7; 95% CI, 1.65-1.78) and >10% (SHR, 2.5; 95% CI, 2.37-2.68); diabetes duration ≥20 years (SHR, 1.25; 95% CI, 1.11-1.41) and, to a lesser extent, female gender, presence of comorbidities, chronic kidney disease and microvascular complications. CONCLUSIONS: Intensification was not undertaken in 1 in 5 patients. Both HbA1c thresholds and time until therapy intensification exceeded current recommendations

Table_1_Clinical characteristics and degree of cardiovascular risk factor control in patients with newly-diagnosed type 2 diabetes in Catalonia.docx

IntroductionWomen with type 2 diabetes mellitus (T2DM) face a greater risk of cardiovascular disease (CVD) and encounter challenges in managing cardiovascular risk factors (CVRF); however, limited data are available in individuals with newlydiagnosed T2DM.MethodsThis study aimed to examine differences between women and men at the onset of T2DM in terms of clinical characteristics, glycaemic status, and CVRF management. This was a retrospective cohort study including subjects with newly-diagnosed T2DM from the System for the Development of Research in Primary Care (SIDIAP) database in Catalonia (Spain). Sex differences (Dif) were assessed at baseline and 1-year post-diagnosis, by calculating the absolute difference of means or proportions.ResultsA total of 13,629 subjects with newly-diagnosed T2DM were analyzed. Women were older and had a higher BMI than men. At baseline, women had higher total cholesterol [Dif (95%CI) 10 mg/dL (9.1/10.8)] and low-density lipoprotein cholesterol (LDL-c) [Dif (95%CI) 7 mg/dL (6.3/7.7)], while men had higher rates of smoking and alcohol intake. Lipid target achievement was lower in women, in both primary prevention (LDL-c ConclusionDifferences between men and women CVRF are already apparent at the onset of T2DM, particularly in primary prevention, with notable differences in lipid profile and target level attainment.</p

DataSheet_1_Obesity and related comorbidities in a large population-based cohort of subjects with type 1 diabetes in Catalonia.docx

IntroductionObesity, an increasing global health problem, can affect people with other disease conditions. The prevalence of obesity in people with type 1 diabetes (T1D) is not well known. The aim of this study was to describe extensively the characteristics and prevalence of different classes of obesity according to BMI (body mass index) categories in a large cohort of patients with T1D.Material and methodsThis was a retrospective, cross-sectional study in Catalonia. We reviewed all patients with T1D diagnosis, ≥ 18 years old and with BMI data from the SIDIAP database. Sociodemographic and clinical data, cardiovascular risk factors, laboratory parameters and concomitant medications were collected.ResultsA total of 6,068 patients with T1D were analyzed. The prevalence of obesity in the total sample was 18% (13.8% with class 1 obesity [BMI 30-34.9 kg/m2]). Patients with obesity had a higher prevalence of other cardiovascular risk factors (i.e. hypertension was 61.4% vs. 37.5%; dyslipidemia 63.6% vs 44%, and chronic kidney disease 38.4% vs. 24.4%; p 25 kg/m2. Patients with obesity did not have poorer glycemic control.ConclusionThe presence of obesity in people with T1D is frequent and cardiovascular risk factors are more common and more poorly controlled in T1D patients with obesity.</p

Patients’ characteristics with respect to diabetic retinopathy.

<p>Patients’ characteristics with respect to diabetic retinopathy.</p

Patients’ characteristics with respect to urine albumin to creatinine ratio (UACR).

<p>Patients’ characteristics with respect to urine albumin to creatinine ratio (UACR).</p

Sociodemographic, lifestyle, and clinical characteristics of subjects with prediabetes at baseline, according to baseline FLI.

<p>Sociodemographic, lifestyle, and clinical characteristics of subjects with prediabetes at baseline, according to baseline FLI.</p

Patients’ characteristics with respect to glomerular filtration rate (eGFR).

<p>Patients’ characteristics with respect to glomerular filtration rate (eGFR).</p

Hazard ratios and 95% confidence intervals of multivariate models for the risk of incident T2D in patients with prediabetes at 3 years of follow-up according to FLI categories.

<p>Hazard ratios and 95% confidence intervals of multivariate models for the risk of incident T2D in patients with prediabetes at 3 years of follow-up according to FLI categories.</p

Urine albumin to creatinine ratio and prevalence of diabetic retinopathy.

<p>*Adjusted by age, sex, age at retinography, duration type 2 diabetes, systolic blood pressure <140 mmHg, A1C ≤ 7%, smoking, cardiovascular disease, BMI, and eGFR. DR, diabetic retinopathy; OR, odds ratio; UACR, urine albumin to creatinine ratio.</p

Association of chronic kidney disease and diabetic retinopathy.

<p>*Adjusted by sex, age at digital photography, duration of type 2 diabetes, systolic blood pressure <140 mmHg, and A1C ≤7%; DR, diabetic retinopathy; eGFR, estimated glomerular filtration rate; UACR, urine albumin to creatinine ratio; VTDR, vision threatening diabetic retinopathy (severe non proliferative DR, proliferative DR, and diabetic macular edema); non-VTDR, mild non-proliferative DR and moderate non-proliferative DR.</p