People with t2 don’t change medication after high BGL results

Friday, 30 October 2020

More than half of people whose type 2 diabetes is not well-controlled are not getting their treatment escalated after having a high HbA1c result, an Australian study reported in the Limbic has concluded.

Data from 2,456 people in NSW with type 2 who had a HbA1c test result over 8.0% found that within six months only 44% of those people had a PBS-dispensed medication showing that their therapy had been escalated.

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).

Definition of treatment escalation

Escalation was defined as adding an oral glucose-lowering drug, a GLP-1 receptor agonist, or insulin to an individual’s existing medications.

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 one medication rather 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.

Multiple medications can be ‘challenging’

“While we didn’t study the specific reasons 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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