Treatment escalation and rise in HbA1c following successful initial metformin therapy

Diabetes Care
Gregory A NicholsJonathan B Brown

Abstract

To describe secondary failure of initial metformin therapy in patients who achieved initial HbA(1c) (A1C) <8% and to identify predictors of failure. We identified 1,288 patients who achieved A1C <8% within 1 year of initiating metformin as their first-ever antihyperglycemic drug. Subjects were followed until they added/switched antihyperglycemics, they terminated health plan membership, or 31 December 2004. We defined secondary failure using two separate but overlapping approaches: 1) addition/switch to another antihyperglycemic drug or 2) first A1C measurement >8.0% after at least 6 months on metformin. The best A1C achieved within 1 year of metformin initiation was the most powerful predictor of avoiding secondary failure. Approximately 50% of subjects whose best A1C was 7-7.9% added/switched antihyperglycemic drugs within 36 months, whereas it took >60 months for those in the 6-6.9% A1C category to reach a 50% failure rate. Those who achieved an A1C <6% did not reach a 50% rate of adding/switching drugs until 84 months. For the alternative secondary failure outcome, about half of those whose best A1C was 7.0-7.9% reached an A1C >8% within 24 months. Only approximately 25% of subjects in the 6-6.9% category failed by 48 month...Continue Reading

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Citations

Mar 21, 2007·Journal of General Internal Medicine·Gregory A NicholsSonali N Shah
Mar 13, 2008·Journal of General Internal Medicine·David C ZiemerLawrence S Phillips
Jul 1, 2008·Journal of General Internal Medicine·Adrianne C FeldsteinNancy Perrin
Jun 11, 2010·Diabetes Technology & Therapeutics·Timothy S Bailey, Steven V Edelman
Nov 10, 2013·Vascular Health and Risk Management·Karoline von WebskyBerthold Hocher
May 14, 2010·Postgraduate Medicine·James R Gavin, Nancy J Bohannon
Dec 15, 2010·Expert Opinion on Pharmacotherapy·Mansur Shomali
Jul 28, 2010·Current Medical Research and Opinion·Gregory A NicholsJonathan B Brown
May 19, 2007·Diabetic Medicine : a Journal of the British Diabetic Association·A SchweizerS Dejager
Jan 23, 2016·Acta Diabetologica·Ram JagannathanMichael Bergman
Jul 17, 2015·International Journal of Clinical Practice·Y Bar-DayanJ Wainstein
Mar 29, 2011·Pharmacoepidemiology and Drug Safety·Egbert J F LambertsMarcel L Bouvy
Aug 13, 2014·International Journal of Clinical Practice·C McAdam-MarxD I Brixner
Oct 27, 2009·The American Journal of Medicine·David S OyerUNKNOWN INITIATEplus Study Group
Jul 9, 2010·The American Journal of Medicine·Vivian A FonsecaJorge Plutzky
Jan 15, 2015·Diabetic Medicine : a Journal of the British Diabetic Association·D P MartonoP Denig
Nov 30, 2010·Diabetes Research and Clinical Practice·Jennifer G TwomblyLawrence S Phillips
Mar 16, 2007·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Gregory A NicholsJonathan B Brown
Sep 25, 2014·Diabetes Care·Lawrence S PhillipsSteven E Kahn
Dec 31, 2009·Diabetes Care·Jonathan B BrownGregory A Nichols
Aug 24, 2016·Current Medical Research and Opinion·Doti P MartonoPetra Denig
May 13, 2011·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Priscilla L HollanderUNKNOWN CV181013 Investigators
May 16, 2017·Current Medical Research and Opinion·Shujie HaoQingqing Lou
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