Release date: 2016-11-01
Trend of blood glucose control (HbA1c) in patients with type 2 diabetes in the United States from 2006 to 2013
In the past decade, many new diabetes drugs have been on the market, which has brought about changes in the treatment of diabetes. However, a recent big data study in the United States showed that new diabetes medications did not lead to better glycemic control and there were many areas where we needed to work.
Diabetes Care, a journal of the American Diabetes Association, uses the US insurance database as a benchmark to analyze trends in the use of diabetes medications, blood glucose control compliance, and hypoglycemia in the United States between 2006 and 2013, and through age, gender, and ethnicity. Adjustment of factors. This insurance database contains information on US government-run Medicare and private health insurance. The study was conducted on a total of 1,657,610 patients diagnosed with type 2 diabetes for at least one year.
Trends in diabetes medication
From 2006 to 2013, the first line of drugs was Biguanides, the secretin-based new drug DPP4 inhibitors (DPP-4 inhibitors), GLP-1 agonists (GLP-1 agonists), and insulin (Any insulin). The use ratio has increased significantly. The proportion of sulfonylureas (Sulfonylureas), which are prone to hypoglycemia, and thiazolidinediones (TZDs), which increase side effects such as body weight, are significantly reduced. See the figure below for details.
Trends in drug use in patients with type 2 diabetes in the United States from 2006 to 2013
Trends in drug use in patients with type 2 diabetes in the United States from 2006 to 2013
Among them, the increase in insulin is mainly due to the increased use ratio of insulin analogs, including long-acting and short-acting insulin analogs, rather than the increase in the use of human insulin.
Blood sugar control
Of the 1,657,610 patients with type 2 diabetes, 25.6% had glycosylated hemoglobin records. The value of glycated hemoglobin was divided into ≥9%, 8%~9%, 7%~8%, 6%~7% and less than 6%. The results showed that the proportion of the two groups with poor glycemic control (≥9% and 8%~9%) increased significantly, while the group with 7%~8% and 6%~7% had no significant change, and the group with less than 6% had no significant change. The proportion has dropped significantly.
Most of the groups with poor glycemic control (HbA1c ≥ 9%) were concentrated in younger ethnic groups (18-44 years old), and there was a slight increase in the 8-year period. The blood glucose control (HbA1c) status of patients with type 2 diabetes in all age groups from 2006 to 2013 is shown in the figure below.
Glycated hemoglobin A1c (HbA1c)
Hemoglobin combined with sugar. The detection of glycated hemoglobin is suitable for judging the average blood glucose level in the past 2 to 3 months.
Trend of blood glucose control (HbA1c) in type 2 diabetes patients aged 18 to 44 years
Trend of blood glucose control (HbA1c) in type 2 diabetes patients aged 45-64 years
Trend of blood glucose control (HbA1c) in type 2 diabetes patients aged 65-74 years
Trend of blood glucose control (HbA1c) in type 2 diabetes patients aged 75 years and older
Hypoglycemia
The proportion of hospitalized patients with severe hypoglycemia did not change significantly during the eight years, and the proportion of hospitalized for 1.3 patients with hypoglycemia was maintained approximately every 100 years. But older people and diabetics with many comorbidities are more likely to develop hypoglycemia than younger and healthier diabetics.
in conclusion
In the eight years from 2006 to 2013, the use of diabetes tends to use blood sugar drugs that are less prone to hypoglycemia and do not increase weight. However, the overall control compliance rate has not improved significantly. Although there is a tendency to use drugs that are less prone to hypoglycemia, the proportion of hypoglycemia has not improved significantly.
Of course, this is only the result of local research in the United States, and it cannot directly reflect the treatment status of diabetic patients in China.
Realistic treatment dilemma
Clinical studies of diabetes drugs before they go on the market tell us that they can effectively improve the condition of hyperglycemia. However, pre-marketing clinical research is often based on a strict standard premise, including strict screening of patients, complete health education, intensive supervision, etc., and does not represent the treatment of diabetic patients in general reality (such as In the real situation, patients may go to see a doctor everywhere, or are unwilling to go back to the clinic, or rarely monitor blood sugar, or simply do not want to receive health education, etc.).
Therefore, in the past decade, we have more safe and not easy to cause hypoglycemia diabetes drugs can be used, but the response in the overall treatment of diabetes, there is no significant improvement.
This means that in the treatment of diabetes, the introduction of new drugs alone cannot achieve the desired results. Diet, exercise and other lifestyle changes, as well as self-health management, are still an important part of diabetes care.
If government agencies really care about the care of people with diabetes, they should invest more resources in health education and establish the ability of self-health management of diabetes patients through systematic health education to improve the care of diabetes.
Reference material
1. Current status of diabetes treatment in the United States
Http://
2.Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006–2013
Http://care.diabetesjournals.org/content/early/2016/09/21/dc16-0985
3.Are Newer Diabetes Drugs Improving Glycemic Control?
Http://
Source: Ikang Guobin
Zhuhai Mingke Electronics Technology Co., Ltd , https://www.zhmkdz-electronics.com