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Individualised treatment targets in patients with type-2 diabetes and hypertension
Roland E Schmieder1, Diethelm Tschöpe2, Cornelia Koch3
1Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. roland.schmieder@uk-erlangen.de.
Insights
Adherence to HbA1c targets in type-2 diabetes mellitus (T2DM) patients with hypertension is poor. Few patients achieved their blood glucose goals, indicating a need for better treatment intensification strategies.
Area of Science:
- Endocrinology and Metabolism
- Cardiovascular Disease Management
- Diabetes Mellitus Research
Background:
- Patients with type-2 diabetes mellitus (T2DM) face elevated cardiovascular event risk, particularly when hypertension is present.
- Current clinical practice adherence to guidelines for reducing HbA1c levels in T2DM remains unclear.
Purpose of the Study:
- To assess the adherence to HbA1c treatment targets in patients with T2DM and hypertension.
- To evaluate the extent of treatment intensification in patients failing to meet their glycemic goals.
Main Methods:
- Prospective, observational, non-interventional DIALOGUE registry conducted across multiple German centers.
- Inclusion of adult T2DM patients with hypertension whose treatment was considered inadequate or unsafe.
- Assignment of patients to strict (≤6.5%), intermediate (>6.5% to ≤7.0%), or lenient (>7.0% to ≤7.5%) HbA1c treatment targets.
Main Results:
- 8568 patients with T2DM and hypertension were enrolled; 78.1% had 12-month follow-up.
- Only 53.1% of patients achieved their assigned HbA1c treatment target.
- Limited treatment intensification was observed in patients who did not achieve their glycemic targets.
Conclusions:
- Achievement of HbA1c treatment targets was suboptimal, resulting in many patients with elevated blood glucose levels.
- Physicians' reluctance to intensify antidiabetic drug therapy is concerning, given the link between hyperglycemia and microvascular complications in T2DM.
Aim:
Patients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice.
Methods:
DIALOGUE was a prospective, observational, non-interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included. Patients were assigned a treatment target HbA1c value (≤ 6.5% [strict]; > 6.5 to ≤ 7.0% [intermediate]; > 7.0 to ≤ 7.5% [lenient]).
Results:
8568 patients with T2DM and hypertension were enrolled. 6691 (78.1%) had 12-month follow-up. Patients who were assigned a strict HbA1c treatment target (n = 2644) were younger, had shorter diabetes duration, and less comorbidity in comparison to those with intermediate (n = 2912) or lenient targets (n = 1135). Only 53.1% of patients achieved their HbA1c treatment target (46.2% [strict], 56.8% [intermediate], 59.4% [lenient]). There was little sign of treatment intensification for patients that had not achieved their HbA1c target.
Conclusions:
Achievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels. The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with T2DM.
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