Treatment Intensification and Risk of Cardiovascular Events in Insulin-Treated Patients with Type 2 Diabetes; A United Kingdom Retrospective Cohort Study
Author(s)
Adan Hag Hersi M1;Seidu S*2;Khunti K2;Zaccardi F2;Gillies C3;Webb DR3;Lubwama R4;Boss A4, Dex T4
1University of Leicester, Leicester, LCE, UK, 2Diabetes Research Centre, Leicester, UK, 3University of Leicester, Leicester, UK, 4Sanofi, New Jersey, NJ, USA
OBJECTIVES: This retrospective observational study aimed to determine the link between cardiovascular events and treatment intensification in T2DM patients treated with basal insulin in UK primary care
METHODS: Using the Clinical Practice Research Datalink, adults diagnosed with T2DM newly initiated with a basal long/intermediate-acting insulin from January 2004 to December 2016 were identified. First change or add on of short or premix insulin and/or OADs was defined as intensification. Patients were categorized into three groups; uncontrolled glycaemia at baseline (≥7% HbA1c) and early (within 1-year) intensifiers, uncontrolled glycaemia at baseline and delayed (>1-year) intensifiers and non-intensifiers with uncontrolled glycaemia (reference group). Patients with previous cardiovascular events (CVDs) were excluded and cox-proportional hazard models that accounted for baseline characteristics was used to asses the risk of CVD events in the cohort subgroups.
RESULTS: A total of n=7,858 patients were included; 32.39% (n=2,545) were uncontrolled-glycaemic-early intensifiers, 26.18% (n=2,057) were uncontrolled glycaemic-delayed intensifiers, and 41.44% (n=3,256) were non-intensifiers. Majority of the early and delayed intensified patients were males (54.38% and 56.15% respectively) and the average age was 61.80years and 60.99 years respectively. Non- intensifiers were older (67.31 years) and had a greater number of risk factors. Median baseline HbA1c was 85.90mmol/mol [10.01%] (IQR, 73.9-101.0mmol/mol; 8.91- 11.39%) and 82.50mmol/mol [9.70%] (IQR, 71.60-96.70mmol/mol, 8.70-11.00%) in the early and delayed treatment intensified group respectively. Early treatment intensification within 1-year post basal insulin therapy was linked to 18% (HR CI: 0.65, 1.03), 23% (HR CI: 0.58, 1.02) and 28% (HR CI: 0.58, 0.93) reduction in the risk of HF, MI and stroke respectively. CVE risk was also reduced in the delayed treatment intensified group.
CONCLUSIONS: a large proportion of patients in primary care remain non-intensified post basal insulin despite poor glycemic control. Timely treatment intensification and careful patient selection is central in minimising CVE complications in type 2 diabetes patients.
METHODS: Using the Clinical Practice Research Datalink, adults diagnosed with T2DM newly initiated with a basal long/intermediate-acting insulin from January 2004 to December 2016 were identified. First change or add on of short or premix insulin and/or OADs was defined as intensification. Patients were categorized into three groups; uncontrolled glycaemia at baseline (≥7% HbA1c) and early (within 1-year) intensifiers, uncontrolled glycaemia at baseline and delayed (>1-year) intensifiers and non-intensifiers with uncontrolled glycaemia (reference group). Patients with previous cardiovascular events (CVDs) were excluded and cox-proportional hazard models that accounted for baseline characteristics was used to asses the risk of CVD events in the cohort subgroups.
RESULTS: A total of n=7,858 patients were included; 32.39% (n=2,545) were uncontrolled-glycaemic-early intensifiers, 26.18% (n=2,057) were uncontrolled glycaemic-delayed intensifiers, and 41.44% (n=3,256) were non-intensifiers. Majority of the early and delayed intensified patients were males (54.38% and 56.15% respectively) and the average age was 61.80years and 60.99 years respectively. Non- intensifiers were older (67.31 years) and had a greater number of risk factors. Median baseline HbA1c was 85.90mmol/mol [10.01%] (IQR, 73.9-101.0mmol/mol; 8.91- 11.39%) and 82.50mmol/mol [9.70%] (IQR, 71.60-96.70mmol/mol, 8.70-11.00%) in the early and delayed treatment intensified group respectively. Early treatment intensification within 1-year post basal insulin therapy was linked to 18% (HR CI: 0.65, 1.03), 23% (HR CI: 0.58, 1.02) and 28% (HR CI: 0.58, 0.93) reduction in the risk of HF, MI and stroke respectively. CVE risk was also reduced in the delayed treatment intensified group.
CONCLUSIONS: a large proportion of patients in primary care remain non-intensified post basal insulin despite poor glycemic control. Timely treatment intensification and careful patient selection is central in minimising CVE complications in type 2 diabetes patients.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PA2
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Disease Management, Electronic Medical & Health Records, Prescribing Behavior, Safety & Pharmacoepidemiology
Disease
Diabetes/Endocrine/Metabolic Disorders