Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study

Young, TK; Hockham, C; Sukkar, L; Kang, A; Jun, M; Foote, C; Baker, J; Rogers, K; Zoungas, S; Cass, A; Sullivan, D; Jardine, MJ

Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study

Young, TK Hockham, C Sukkar, L Kang, A Jun, M Foote, C Baker, J Rogers, K

Zoungas, S Cass, A Sullivan, D Jardine, MJ

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Endocrine and Metabolic Science, 2023, 12, pp. 100135
Issue Date:: 2023-09-30

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Field	Value	Language
dc.contributor.author	Young, TK
dc.contributor.author	Hockham, C
dc.contributor.author	Sukkar, L
dc.contributor.author	Kang, A
dc.contributor.author	Jun, M
dc.contributor.author	Foote, C
dc.contributor.author	Baker, J
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Zoungas, S
dc.contributor.author	Cass, A
dc.contributor.author	Sullivan, D
dc.contributor.author	Jardine, MJ
dc.date.accessioned	2023-09-25T03:36:52Z
dc.date.available	2023-09-25T03:36:52Z
dc.date.issued	2023-09-30
dc.identifier.citation	Endocrine and Metabolic Science, 2023, 12, pp. 100135
dc.identifier.issn	2666-3961
dc.identifier.issn	2666-3961
dc.identifier.uri	http://hdl.handle.net/10453/172268
dc.description.abstract	Background: Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence. Methods: We performed an episode-based analysis of the EXTEND-45 dataset, assessing trends in glucose lowering therapy and the associated outcomes of HbA1c and treatment persistence. Trends from 2009 to 2014 were assessed for each intensity level of a glucose lowering therapy regimen, according to the year prescribed. Episodes were defined as the length of time that an individual adhered to a regimen through ongoing prescription, and this was used as to define persistence. Mean HbA1c were calculated for each episode. Persistence and HbA1c were compared across the different regimens of treatment intensity. Results: The intensity of glucose lowering therapy remained stable over time with around one third of episodes utilising a single glucose lowering agent. Mean HbA1c was higher for insulin-based treatment (mean 7.9 % SD = 1.3 %), and lowest for episodes of no glucose lowering treatment (mean 6.3 % (SD = 0.8 %). Around half of participants achieved glycemic targets of 7 %. While there was considerable variation in persistence, the median persistence was around 3 months (94 days, IQR 51–201 days). Conclusions: Therapeutic intensity for diabetes has remained stable over 9 years. Whilst there was considerable variability in persistence with glucose lowering regimens, the mean duration of all regimens was less than a year. Requirement for higher intensity treatment with insulin was related to poorer glycemic control.
dc.language	en
dc.publisher	Elsevier
dc.relation.ispartof	Endocrine and Metabolic Science
dc.relation.isbasedon	10.1016/j.endmts.2023.100135
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3202 Clinical sciences
dc.subject.classification	3205 Medical biochemistry and metabolomics
dc.title	Duration and effectiveness of glucose-lowering regimens in the real world management of diabetes: Data from the Australian EXTEND45 Linked Cohort Study
dc.type	Journal Article
utslib.citation.volume	12
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.date.updated	2023-09-25T03:36:50Z
pubs.publication-status	Accepted
pubs.volume	12

Abstract:

Background: Diabetes is a common condition that often requires increasing intensity of glucose lowering regimens. We describe the population trends in the intensity of regimens, and associations of achieved HbA1c and treatment persistence. Methods: We performed an episode-based analysis of the EXTEND-45 dataset, assessing trends in glucose lowering therapy and the associated outcomes of HbA1c and treatment persistence. Trends from 2009 to 2014 were assessed for each intensity level of a glucose lowering therapy regimen, according to the year prescribed. Episodes were defined as the length of time that an individual adhered to a regimen through ongoing prescription, and this was used as to define persistence. Mean HbA1c were calculated for each episode. Persistence and HbA1c were compared across the different regimens of treatment intensity. Results: The intensity of glucose lowering therapy remained stable over time with around one third of episodes utilising a single glucose lowering agent. Mean HbA1c was higher for insulin-based treatment (mean 7.9 % SD = 1.3 %), and lowest for episodes of no glucose lowering treatment (mean 6.3 % (SD = 0.8 %). Around half of participants achieved glycemic targets of 7 %. While there was considerable variation in persistence, the median persistence was around 3 months (94 days, IQR 51–201 days). Conclusions: Therapeutic intensity for diabetes has remained stable over 9 years. Whilst there was considerable variability in persistence with glucose lowering regimens, the mean duration of all regimens was less than a year. Requirement for higher intensity treatment with insulin was related to poorer glycemic control.

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