Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes: translating research into action for diabetes (TRIAD).
OBJECTIVE
The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C.


METHODS
We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months.


RESULTS
Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 +/- 12 years, had diabetes duration of 11 +/- 9 years, and had A1C of 9.1 +/- 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits.


CONCLUSIONS
Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control.
McEwen
Laura N
LN
Department of Internal Medicine/Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA. lmattei@med.umich.edu
Bilik
Dori
D
Johnson
Susan L
SL
Halter
Jeffrey B
JB
Karter
Andrew J
AJ
Mangione
Carol M
CM
Subramanian
Usha
U
Waitzfelder
Beth
B
Crosson
Jesse C
JC
Herman
William H
WH
D017668:Age of Onset; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents