Objectives:

To evaluate the prevalence of early treatment modification and estimate its impact on glycemic control, diabetic complications, and healthcare utilization in patients with type 2 diabetes (T2D) and HbA1c ≥9%.

Methods:

A retrospective cohort of 28,529 patients with T2D between 18 and 90 years of age were indexed at their first HbA1c measure ≥9% between January 1 and December 31, 2016, using the Optum® Clinformatics® Data Mart Database. Patients were segmented into two groups: 1) early treatment modification (within 90 days of index HbA1c ≥9%) and 2) delayed (>90 days post-index) or no treatment modification, defined as the addition or switching of T2D medication. Post-index ΔHbA1c was assessed at 6-12 months; diabetic complications and healthcare utilization were assessed at 36 months.

Results:

Most (59%, n=16,904) patients received early treatment modification, while 41% of patients (n=11,625) received delayed or no treatment modification. There were higher proportions of delayed treatment with increased treatment complexity at index date: metformin (40%), two oral antidiabetics (54%), three oral antidiabetics (65%). Follow-up HbA1c values were available for 68% of patients in both the early (n=11,534) and delayed (n=7,897) treatment groups. Baseline mean HbA1c levels were significantly higher in the early treatment group than the delayed treatment group (10.3% vs 10.1%, p<0.01), and decreased by a significantly greater amount at follow-up (-1.46 vs -1.05, p<0.01). Diabetes Complication Severity Index (DCSI) scores were significantly lower for the early treatment group at baseline (1.80 vs 2.04, p<0.01) and 36 months (3.42 vs 3.56, p<0.01). The early treatment modification group had significantly fewer outpatient visits (53.51 vs 54.93, p=0.02) at 36 months.

Conclusions:

Early treatment modification was significantly associated with improved glycemic control and decreased outpatient visits in this cohort of patients with elevated HbA1c levels. Further work is needed to understand impact of treatment modification on diabetes complications.