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Impact of Second-Line Combination Treatment for Type 2 Diabetes Mellitus on Disease Control: A Population-Based

Dan Ouchi1,2,3, Carles Vilaplana-Carnerero4,5,6, Ramon Monfà4,5,6

  • 1Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain. douchi@idiapjgol.info.

Drugs - Real World Outcomes
|May 9, 2023
PubMed
Abstract

Insights

Second-line treatments for type 2 diabetes effectively lower glycated hemoglobin. Glucagon-like peptide-1 and insulin combinations achieve glycemic control faster than sulfonylureas, improving patient outcomes.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacotherapy

Background:

  • Type 2 diabetes mellitus affects millions globally, necessitating effective glycemic control to prevent complications.
  • Metformin monotherapy is a common first-line treatment, but many patients require additional agents for adequate blood sugar management.

Purpose of the Study:

  • To evaluate the impact of initiating combination therapies on reducing glycated hemoglobin (HbA1c) in type 2 diabetes patients with insufficient glycemic control.
  • To compare the efficacy of various second-line treatment strategies against sulfonylurea combinations.

Main Methods:

  • Retrospective analysis of 28,425 patients diagnosed with type 2 diabetes between 2015-2020 from the SIDIAP database.
  • Primary outcome: time to achieve HbA1c control (≤7%) within 720 days, measured by restricted mean survival time (RMST).
  • Medication adherence assessed via medication possession ratio; treatment performance compared using adjusted RMST differences.

Main Results:

  • All evaluated second-line treatments reduced HbA1c levels.
  • Glucagon-like peptide-1 (GLP-1) and insulin combinations achieved glycemic control significantly earlier than sulfonylurea combinations (p < 0.001).
  • GLP-1 and sodium-glucose cotransporter type 2 (SGLT2) inhibitors demonstrated significant weight reduction; adherence positively impacted glycemic control in most groups.

Conclusions:

  • Second-line treatments are effective in achieving glycemic targets for type 2 diabetes patients.
  • GLP-1 receptor agonists and insulin combinations offer faster HbA1c control compared to sulfonylureas.
  • High adherence is crucial for timely glycemic control, with notable exceptions for SGLT2 inhibitor combinations.

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