(81) Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients with Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 412

Presenting Author(s)

Petra Denig, PharmD, PhD, FISPE
– PhD, FISPE, University Medical Center Groningen, University Medical Center Groningen, Groningen, Netherlands

Co-Author(s)

Martina Ambroz
– University Medical Center Groningen, The Netherlands, Groningen, Groningen, Netherlands
Sieta de Vries
– Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands, Netherlands
Klaas Hoogenberg
– Internist, Netherlands

Background: Guidelines started to recommend more personalized treatment targets for patients with type 2 diabetes in the last decade, particularly allowing for higher risk factor levels in older patients. In the years up to 2014, little age differentiation was seen in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering treatment.

Objectives: To assess trends in HbA1c and SBP thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes between 2015 and 2020 and assess the influence of age and sex on these trends.

Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age, or sex and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication.

Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), particularly significant in the younger age groups. Compared to patients aged ≥80 years, patients aged 60-69 years initiated medication at lower levels mainly in the first years. Patients < 60 years and between 70-79 years initiated medication at similar levels as patients aged ≥80 years. Females initiated glucose-lowering medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p=0.676). There were no significant differences in SBP thresholds between patients of different ages or sex.

Conclusions: The rising trend in the HbA1c threshold at initiation of glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for further health systems interventions.