ORIGINAL ARTICLE

Treatment Patterns and Associated Clinical Outcomes in Type 2 Diabetes Patients Initiating Second-Line Glucose-Lowering Therapy: Interim Analysis of Baseline Data from Turkey Arm of the Global DISCOVER Study
İkinci-Sıra Glukoz Düşürücü Tedaviye Başlanan Tip 2 Diyabet Hastalarında Tedavi Uygulamaları ve İlişkili Klinik Sonuçlar: Global DISCOVER Çalışması Türkiye Kolu Başlangıç Verilerinin Ara Analizi
Received Date : 07 Jan 2021
Accepted Date : 23 May 2021
Available Online : 09 Jun 2021
Doi: 10.25179/tjem.2021-81148 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:202-215
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
To evaluate the treatment patterns and associated clinical outcomes in Type 2 diabetes (T2D) patients initiating a second-line glucose-lowering therapy. Material and Methods: This paper presents a preliminary subgroup analysis of the baseline data collected from 536 patients [mean (standard deviation) age: 55.1 (10.0) years, 50.2% were males] in the Turkey arm of global observational DISCOVER study among T2D patients initiating second-line glucose-lowering therapy. Patient demographics, disease (duration, complications) and treatment (type of regimens, modifications) characteristics, hemoglobin A1c (HbA1c), low-density lipoprotein-cholesterol (LDL-C), and systolic blood pressure (BP) target achievement rates and the patient-reported outcomes were recorded at the initiation of second-line therapy. Results: Overall, 11.7% of patients were HbA1c target of <7% at baseline, 62.5% were systolic BP target of <140 mmHg and 21.2% were LDL-C target of <100 mg/dL. Major and minor hypoglycemic events were noted in 5.5% and 10.7% of patients, while macro and microvascular complications in 17.2% and 20.1% of patients, respectively. Metformin monotherapy (47.9%) and metformin+sulfonylurea combination (22.6%) were the two most common first-line therapies. However, insulin (32.3%) was the most commonly prescribed second-line agent. Lifestyle assessment revealed a healthy lifestyle in 50.7% of patients. Conclusion: Our finding revealed a failure to achieve HbA1c, LDL-C, and systolic BP targets and a high rate of diabetes-related complications before initiation of second-line therapy in a significant proportion of Turkish T2D patients. Thus, emphasizing a need for more aggressive risk factor screening and modification at early disease stages and earlier treatment intensification among T2D patients.
ÖZET
İkinci-sıra glukoz düşürücü tedaviye başlanan Tip 2 diyabet (T2D) hastalarında, tedavi uygulamaları ve ilişkili klinik sonuçların değerlendirilmesidir. Gereç ve Yöntemler: Bu makalede, ikinci-sıra glukoz düşürücü tedaviye başlanan T2D hastaları ile yürütülen küresel gözlemsel DISCOVER çalışması Türkiye kolunda yer alan 536 hastanın [ortalama (standart sapma) yaş: 55,1 (10,0) yıl, %50,2 erkek hasta], başlangıç verilerine yönelik ara analiz sunulmaktadır. Hastaların demografik özellikleri, hastalık özellikleri (süre, komplikasyonlar) ve tedavilerin (uygulanan rejimler, değişimler) yanı sıra hemoglobin A1c (HbA1c), düşük yoğunluklu lipoproteinkolesterol [low-density lipoprotein-cholesterol (LDL-C)] ve sistolik kan basıncı (KB) hedeflerine ulaşan hasta yüzdesi ve hasta bildirimli sonuçlar, ikinci-sıra tedavi başlangıcında kaydedildi. Bulgular: Toplamda hastaların %11,7’sinde HbA1c (<%7), %62,5’inde KB (<140 mmHg) ve %21,2’sinde LDL-C (<100 mg/dL) hedef değerlerde bulundu. Majör ve minör hipoglisemik olaylar hastaların sırasıyla %5,5 ve %10,7’sinde gözlenirken; makrovasküler ve mikrovasküler komplikasyon oranları sırasıyla %17,2 ve %20,1 olarak saptandı. Metformin monoterapisi (%47,9) ve metformin+ sülfonilüre kombinasyonu (%22,6) en yaygın 2 ilk-sıra tedavi seçeneği olup, insülin (%32,3) en sık reçetelenen ikinci-sıra ajandı. Hastaların %50,7’sinde, sağlıklı yaşam biçimi varlığı tespit edildi. Sonuç: Sonuç olarak bulgularımız, Türk T2D hastalarında ikinci-sıra tedaviye geçiş öncesi HbA1c, LDL-C ve sistolik KB hedeflerinin, hastaların önemli bir kısmında karşılanamadığına ve mikrovasküler ve makrovasküler komplikasyon oranlarının yüksekliğine işaret etmektedir. Bu doğrultuda, erken evre hastalık döneminde risk faktörü tarama ve modifikasyonları açısından daha sıkı bir stratejiye ve daha erken dönemde tedavi yoğunlaştırmasına gereksinim olduğunu vurgulamaktadır.
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