No therapy escalation for most T2D patients following elevated HbA1c

Dr Carinna Hockham

More than half of people whose type 2 diabetes is not well-controlled are not getting their treatment escalated after having an elevated HbA1c result, an Australian study suggests

Data from 2,456 people in NSW with T2D who had a HbA1c test result over 8.0% found that only 44% had a PBS dispensed medication indicating therapy escalation within 6 months.

The findings, published in Diabetes Care, are derived from non–insulin-using individuals presumed to have type 2 diabetes, over the age of 45 enrolled in the EXamining ouTcomEs in chronic Disease in the 45 and Up Study (EXTEND45).

Escalation was defined as the addition of oral glucose-lowering drug, a GLP-1 receptor agonist, or insulin to the individual’s existing regimen.

Researchers at the George Institute for Global Health found that therapy escalation was more likely for HbA1c results occurring in individuals who had more engagement with their GP  in the previous 90 days and had visited a consultant physician than those who saw their doctor less frequently.

Treatment escalation was also more likely for patients on monotherapy than people who were on multiple medications already.

“Our study used routinely-collected health data to paint a picture of quality of care for older people with diabetes and it reinforced how important healthcare engagement is to optimising therapy,” said Dr Carinna Hockham, the senior author and Research Fellow at The George Institute.

“While we didn’t study the specific reasons for why certain factors delayed treatment progression, we know that keeping up with multiple medications can be challenging for people with diabetes, so there may be some reluctance to adding in another one,” she said.

“This was echoed by the fact that those who were on just one medication at the time of their elevated result were more likely to be prescribed an additional therapy.”

“We think that slower escalation of therapy in older patients is likely to be due to these concerns,” added Dr Hockham.

“Measuring time to therapy escalation in response to an elevated HbA1c is a useful indicator of quality of care of people with diabetes, and our findings can be used as a baseline for assessing future changes,” the study authors concluded.

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