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 Researchers analyzed data on 1.6 million adults with diabetes from
2006 to 2013. During this period, the proportion with HbA1c below 7%
declined from 56 percent to 54 percent, and the share with HbA1c at
or above 9% rose from 10 percent to 12 percent.
“Clearly, there is a sizeable proportion of patients with poor
glycemic control – and many of them are young,” said lead study
author Kasia Lipska of Yale University in New Haven, Connecticut.
“We need to do better for them.”
The researchers examined data on prescriptions and blood sugar test
results to see how changes in medication utilization might relate to
shifts in the proportion of diabetics with healthy blood sugar.
Use of thiazolidinediones plummeted from 2006 to 2013 when one drug
in this class (rosiglitazone) was linked to an increased risk of
heart attack, stroke and congestive heart failure. Thiazolidinedione
prescriptions accounted for less than 6 percent of the market share
for diabetes drugs by the end of the study period, down from 29
percent at the start.
Prescriptions also fell for sulfonylureas. These medicines accounted
for 31 percent of prescriptions at the end of the study, down from
39 percent.
Meanwhile, DPP-4 inhibitors, introduced around the start of the
study period, accounted for 15 percent of prescriptions by 2013.
(These drugs include sitagliptin, saxagliptin and vildagliptin, for
example.)
Prescriptions for metformin rose from 48 percent to 54 percent over
the course of the study.
The study didn’t explore why shifts in drug utilization or changes
in glycemic control occurred, but it’s possible at least some
patients were using less effective medicines by the end of the
study, Lipska said by email.
“Many of the newer medications have the advantages of not causing
weight gain or hypoglycemia, however, some are not as potent in
lowering blood sugar levels as many of the older medications,”
Lipska said.
“In addition, just because medications are available and put into
use doesn’t mean that they are necessarily applied in ways that
improve care,” Lipska added.
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One limitation of the study is its focus on people with private
insurance or Medicare who may be more likely to take expensive newer
medicines than uninsured patients, the authors note in Diabetes
Care, online September 22.
Another drawback is that researchers only had blood sugar data for
about 25 percent of the people in the study, noted Dr. David Nathan,
director of the Massachusetts General Hospital Diabetes Center in
Boston.
“Other data have suggested a major improvement in diabetes control
over the past 20 years,” Nathan, who wasn’t involved in the study,
said by email.
Recently, however, despite the introduction of new drugs,
improvement in blood sugar control has leveled out, Nathan said.
“The new medicines are substantially more expensive without obvious
benefits.”
With so many drugs to choose from, it’s also possible people are
overlooking the role of diet and exercise in managing the disease,
said Dr. William Herman, a researcher at the University of Michigan
in Ann Arbor who wasn’t involved in the study.
“Obesity and lack of focus on diet and physical activity may
certainly be contributing to the lack of improvement in blood sugar
control,” Herman said by email.
SOURCE: http://bit.ly/2e4lxok
Diabetes Care 2016.
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