Early versus late intensification of glucose-lowering therapy in patients with type 2 diabetes: Results from the DISCOVER study

Abstract

Aims

To assess the effects of glycated haemoglobin (HbA_1c) levels at time of glucose-lowering treatment intensification in DISCOVER, a global observational study of patients with type 2 diabetes (T2D) initiating second-line therapy. Outcomes of interest were glycaemic control, hypoglycaemia, and need for further intensification during 3 years of follow-up.

Methods

We included patients who intensified treatment (add-on or insulin initiation) upon initiation of second-line therapy (baseline). Outcomes were assessed according to baseline HbA_1c: HbA_1c ≤ 7·5% (early intensification) or HbA_1c > 7·5% (late intensification). Factors associated with early or late intensification were assessed using multivariate logistic regression.

Results

Of the 9575 patients included, 3275 (34·2%) intensified treatment early and 6300 (65·8%) intensified treatment late. During follow-up, mean (SD) HbA_1c was lower in the early- than in the late-intensification group (6·9% [0·95%] vs 7·5% [1·28%] at 36 months). More patients had HbA_1c < 7·0% in the early- than in the late-intensification group (61·8% vs 37·9% at 36 months; p < 0·001). The risk of further intensification was higher in the late-intensification group (hazard ratio 1·88 [95% confidence interval 1·68–2·09]). Occurrence of hypoglycaemia was similar in both groups.

Conclusions

Late intensification of glucose-lowering therapy after first-line treatment failure reduces the likelihood of reaching recommended treatment goals.