

What's This?
Among individuals with type 2 diabetes who achieve glycemic control with metformin, those who initiate the drug soon after diabetes is diagnosed when A1C is still low are more likely to sustain glycemic control long term, according to data from an observational cohort study. Researchers evaluated rates and predictors of secondary treatment failure in 1,799 patients with type 2 diabetes who were members of Kaiser Permanente Northwest and who achieved an A1C level =7.5% or the...
Among individuals with type 2 diabetes who achieve glycemic control with metformin, those who initiate the drug soon after diabetes is diagnosed when A1C is still low are more likely to sustain glycemic control long term, according to data from an observational cohort study.
Researchers evaluated rates and predictors of secondary treatment failure in 1,799 patients with type 2 diabetes who were members of Kaiser Permanente Northwest and who achieved an A1C level <7% after initiating metformin monotherapy as first-line treatment.
The investigators reviewed A1C values through the end of 2008 (ie, during 2 to 5 years of follow-up) to identify cases of secondary treatment failure, defined as a subsequent A1C level >=7.5% or the addition/substitution of another diabetes drug.
During the follow-up period, 748 patients (42%) experienced secondary treatment failure, yielding a mean annual failure rate of 17%. The study authors noted that this rate is higher than the rates typically reported in clinical trials such as the ADOPT trial, which reported a rate of 4% (with failure defined as a fasting plasma glucose level >180 mg/dL [corresponding to an A1C level of approximately 8%]).
Among the patients who initiated metformin within 3 months of receiving a diabetes diagnosis (40% of the population), the age- and A1C-adjusted annual rate of treatment failure was 12.2% compared with 17.7% to 21.9% among the patients who waited >=4 months to start treatment. Similarly, the adjusted annual rate of treatment failure was 12.3% among the patients who initiated therapy with an A1C level <7% (27% of the cohort) compared with 17.8% to 19.4% among the patients who had higher A1C levels at the start of therapy.
In a multivariable analysis that included 20 possible risk factors for secondary treatment failure, the only significant predictors were a younger age at diagnosis, a greater time from diagnosis to the start of therapy, and a higher A1C level at the start of therapy.
Sensitivity analyses in which the failure threshold was adjusted to either 7% or 8% (from 7.5%) did not change the results, the researchers noted.
Although the authors acknowledged certain limitations to the analysis, many of which could be attributed to its observational design, they concluded that these findings are "consistent with the hypothesis that early initiation of metformin preserves beta-cell function and supports the current American Diabetes Association/European Association for the Study of Diabetes hyperglycemia treatment algorithm, which recommends metformin therapy as soon as type 2 diabetes is diagnosed." (Brown JB, et al. Diabetes Care 2010;33:501-506.)
What's This?
Among adults without diabetes, elevated levels of hemoglobin A1C and fasting plasma glucose (FPG) are similarly associated with diabetes risk, but A1C seems to be a better predictor of cardiovascular disease (CVD) and all-cause death, according to an analysis of data from the ARIC study.
What's This?
Among treatment-naive patients with type 2 diabetes, sitagliptin phosphate, an oral dipeptidyl peptidase-IV inhibitor, appears to be noninferior to metformin for improving hemoglobin A1C levels and to have a better gastrointestinal (GI) safety profile, according to new findings.
What's This?
An employer-based pharmacist intervention designed to give patients with diabetes individualized care and engage them in the management of their health is associated with significant reductions in hemoglobin A1C levels, blood pressure (BP), and health care use after 1 year, new findings indicate.
What's This?
In a recently published science advisory, the American Heart Association (AHA) and the American College of Cardiology (ACC) concluded that there is insufficient evidence to determine whether the use of thiazolidinediones (TZDs) in general and rosiglitazone maleate in particular increases the risk of ischemic heart disease (IHD) events.