HbA1c <7.0% 6 Months after Initiation of Second-Line Therapy in Patients with Uncontrolled Type 2 Diabetes Is Associated with Good Glycemic Control at 3 Years: The DISCOVER Study

ABSTRACT

Background: DISCOVER is a 3-year, observational study of people with type 2 diabetes (T2D) initiating a second-line glucose-lowering therapy in 38 countries. We assessed glycemic control after 3 years in participants with HbA1c ≥ 9.0% at baseline. Methods: Factors associated with an increased likelihood of having HbA1c < 7.0% after 3 years were assessed using a hierarchical logistic regression model. Results: Of 14 691 DISCOVER participants from 37 countries, 2233 (15.2%) had sufficient HbA1c data and HbA1c ≥ 9.0% at baseline. The majority of participants were men (58.0%), and the mean age was 54.4 years (SD 11.2 years). The mean HbA1c at baseline was 10.4% (SD 1.4%). After 3 years, 626 participants (28.0%) had HbA1c < 7.0% and 438 (19.6%) had HbA1c ≥ 9.0%. Time since T2D diagnosis ≥ 10 years (vs.< 5 years) was associated with a decreased likelihood of having HbA1c < 7.0% at 3 years (Figure). Second-line therapy with two or more glucose-lowering drugs (vs. insulin) and having HbA1c < 7.0% at 6 months (24.2% of patients) were associated with an increased likelihood of having HbA1c < 7.0% at 3 years. Conclusions: Less than a third of participants with HbA1c ≥ 9.0% at initiation of second-line therapy reached HbA1c < 7.0% after 3 years. Early glycemic control (HbA1c < 7.0% at 6 months) was a key factor associated with attaining this target. Disclosure F. Bonnet Consultant;Self;Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. H. Chen None. A. Cooper Employee;Self;AstraZeneca. M.B. Gomes None. L. Ji None. P. Leigh Employee;Self;AstraZeneca. Employee;Spouse/Partner;Merck Sharp & Dohme Corp. L. Ramirez Gutierrez None. M.V. Shestakova None. I. Shimomura Advisory Panel;Self;AstraZeneca K.K., Daiichi Sankyo, Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Consultant;Self;MSD K.K., Novo Nordisk Pharma Ltd. Research Support;Self;Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau;Self;Amgen Astellas BioPharma K.K., Astellas Pharma Inc., AstraZeneca K.K., Covidien Japan Inc., Daiichi Sankyo, Eli Lilly Japan K.K., KOBAYASHI Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Nippon Boehringer Ingelheim Co. Ltd., Nippon Chemiphar Co., Ltd., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Rohto Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. A. Siddiqui None. F. Tang Research Support;Self;AstraZeneca. J. Vora Other Relationship;Self;AstraZeneca. H. Watada Advisory Panel;Self;Abbott, Ajinomoto, Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Fuji Film, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Research Support;Self;Astellas Pharma Inc., Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Yakult. Speaker's Bureau;Self;stellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. K. Khunti Advisory Panel;Self;Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member;Self;AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant;Self;Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support;Self;AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker's Bureau;Self;Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Funding: AstraZeneca [ABSTRACT FROM AUTHOR] Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. 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