title: Glycemic response to newly initiated diabetes therapies.
abstract: OBJECTIVE
  The glycemic response to antihyperglycemic therapies for type 2 diabetes has been thoroughly evaluated in randomized controlled trials, but inadequately studied in real-world settings.
  
  
  METHODS
  We studied glycemic response among 15 126 type 2 diabetic patients who initiated any single new antihyperglycemic agent (metformin, sulfonylureas, thiazolidinediones, or insulin added to medical nutrition therapy or to existing diabetes therapies) during 1999-2000 within Kaiser Permanente of Northern California, an integrated healthcare delivery system.
  
  
  METHODS
  Pre-post (3-12 months after initiation) change in glycosylated hemoglobin (A1C) was analyzed using ANCOVA (analysis of covariance) models adjusted for baseline A1C, concurrent (ongoing) antihyperglycemic therapy, demographics, health behaviors, medication adherence, clinical factors, and processes of care.
  
  
  RESULTS
  Mean A1C was 9.01% (95% confidence interval [CI] 8.98%-9.04%) before therapy initiation and 7.87% (95% CI 7.85%-7.90%) 3 to 12 months after initiation (mean A1C reduction 1.14 percentage points; 95% CI 1.11-1.17). Overall, 30.2% (95% CI 29.2%-31.1%) of patients achieved glycemic target (A1C < 7%). Although baseline disease severity and concurrent therapies differed greatly across therapeutic classes, after adjustment for these baseline clinical characteristics, no significant differences were noted in glucose-lowering effect across therapeutic classes. Treatment effects did not differ by age, race, diabetes duration, obesity, or level of renal function.
  
  
  CONCLUSIONS
  Metformin, sulfonylures, thiazolidinediones, and insulin were equally effective in improving glucose control. Nonetheless, most patients failed to achieve the glycemic target. Findings suggest that, to keep up with progressive worsening of glycemic control, patients and providers must commit to earlier, more aggressive therapy intensification, triggered promptly after A1C exceeds the recommended glycemic target.
authors.affiliation: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA. andy.j.karter@kp.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Jennifer
authors.initials: J
authors.lastname: Liu
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.forename: Ameena T
authors.initials: AT
authors.lastname: Ahmed
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D038321:Glycemic Index; D006305:Health Status Indicators; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones