The American Diabetes Association 72nd Scientific Sessions:
Patients Who Fail Multiple OADs: Add a Third Agent or Suggest Insulin?
Type 2 diabetes patients may encounter this challenge: they may not achieve the blood glucose goals they would like with multiple oral antidiabetic agents (OADs). At that point, practitioners have a choice for how to continue treating. They can add a third OAD, use a GLP-1 agonist, or prescribe insulin.
In order to look at how this challenge is being dealt with in the clinical setting, a recent study examined data from IMPACT ® (a managed care claim database). This research was presented at the American Diabetes Association 72nd Scientific Sessions in a poster called “Treatment Patterns and A1c Reduction After Adding a 3rd Agent to 2 Oral Antidiabetic Drugs (OADs).”1
Data from 200o to 2011 were analyzed. The index drug was the third agent added, and the patients were grouped by index drug added: third OAD (3OAD), GLP-1 agonist (+GLP1), and insulin (+ins). There were 51,771 patients, and they fell into the following groups:
- 3OAD: 79.3%
- +ins: 17.3% (This group had the highest A1c levels, and they were the oldest.)
- +GLP1: 7.4% (This group had the lowest baseline A1c levels, and they were the youngest.)
One-year and two-year follow-up persistence (no switching or discontinuing the index drug) and A1c results were noted.
Third Oral Antidiabetic Agent Results
- Persistent at 1-year but switched before 2-year: 8.9%
- Persistent at 1-year and 2-years: 72%
- Switched before 1-year: 8.8%
- Total 2-year A1c reduction (for all 3OAD patients, regardless of persistence): -0.64 ± 1.65
- Persistent at 1-year but switched before 2-year: 9.0%
- Persistent at 1-year and 2-years: 57.1%
- Switched before 1-year: 24.7
- Total 2-year A1c reduction (for all +ins patients, regardless of persistence): -0.88 ± 1.92
GLP-1 Agonist Results
- Persistent at 1-year but switched before 2-year: 17.3%
- Persistent at 1-year and 2-years: 35.6%
- Switched before 1-year: 39.8%
- Total 2-year A1c reduction (for all +GLP1 patients, regardless of persistence): -0.33 ± 1.52
What the Results Mean
This database analysis showed that most type 2 diabetes patients choose to go on a third oral antidiabetic agent after failing 2 other OADs.
For patients who added insulin after failing 2 OADs showed the biggest reduction in A1c over 2 years (for the persistent patients).
This data shows the need for prescribing insulin to type 2 diabetes patients who have failed 2 oral antidiabetic agents—and then encouraging them to stay on insulin.