Predictors and Impact of Intensification of Antihyperglycemic Therapy in Type 2 Diabetes

• Published in: Diabetes care Vol. 32; no. 6; pp. 971 - 976
• Main Authors: McEwen, Laura N., Bilik, Dori, Johnson, Susan L., Halter, Jeffrey B., Karter, Andrew J., Mangione, Carol M., Subramanian, Usha, Waitzfelder, Beth, Crosson, Jesse C., Herman, William H.
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01.06.2009
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc08-1911

Predictors and Impact of Intensification of Antihyperglycemic Therapy in Type 2 Diabetes Translating Research into Action for Diabetes (TRIAD) Laura N. McEwen , PHD 1 , Dori Bilik , MBA 1 , Susan L. Johnson , MD, MS 1 , Jeffrey B. Halter , MD 2 , Andrew J. Karter , PHD 3 , Carol M. Mangione , MD 4 , Usha Subramanian , MD 5 , Beth Waitzfelder , PHD 6 , Jesse C. Crosson , PHD 7 and William H. Herman , MD, MPH 1 , 8 1 Department of Internal Medicine/Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan; 2 Department of Internal Medicine/Geriatric Medicine, University of Michigan, Ann Arbor, Michigan; 3 Kaiser Permanente, Oakland, California; 4 University of California, Los Angeles, Los Angeles, California; 5 Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; 6 Pacific Health Research Institute, Honolulu, Hawaii; 7 Department of Family Medicine, New Jersey Medical School and Research Division, Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry New Jersey, Somerset, New Jersey; 8 Department of Epidemiology, University of Michigan, Ann Arbor, Michigan. Corresponding author: Laura N. McEwen, lmattei{at}med.umich.edu . Abstract OBJECTIVE The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C. RESEARCH DESIGN AND METHODS We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months. RESULTS Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 ± 12 years, had diabetes duration of 11 ± 9 years, and had A1C of 9.1 ± 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C ( P < 0.0001), a 3-pound increase in weight ( P = 0.003), and no change in anxiety/depression ( P = 0.5) or health status ( P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits. CONCLUSIONS Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control. Footnotes The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding organizations. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received October 21, 2008. Accepted February 12, 2009. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. © 2009 by the American Diabetes Association.