SAN DIEGO — Despite a rise in the number of treatment regimens for adults with type 2 diabetes during the 1990s, national surveys showed no improvement in the number of adults who achieved glycemic control, Tao Fan reported in a poster session at the annual scientific sessions of the American Diabetes Association.
The finding suggests “there should be more aggressive therapy—particularly pharmacotherapy—for type 2 diabetes patients,” Mr. Fan told FAMILY PRACTICE NEWS.
He and his associates analyzed a sample of 1,215 subjects from National Health and Nutrition Examination Survey III (NHANES III, 1988–1994) and 758 subjects from NHANES 1999–2002.
All subjects reported a diagnosis of type 2 diabetes and had data on diabetes medication and hemoglobin A1c levels, Mr. Fan said. He is a doctoral student in the department of pharmaceutical health services research at the University of Maryland, Baltimore.
The researchers defined four therapeutic regimens: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin.
From NHANES III to NHANES 1999–2002, glycemic control rates dropped from 44.3% to 39.8% in subjects aged 65 years and older, but increased from 15.8% to 16.2% in those aged 20–44 and from 39.9% to 44.0% in those aged 45–64.
Diet as sole therapy decreased from 27.4% to 18.7% between the two surveys, as did insulin-only therapy (from 24.2% to 14.0%).
At the same time, the use of OADs alone increased from 45.4% to 57.4% and the use of OADs plus insulin increased from 3.1% to 10%.
Mr. Tao and his associates adjusted the analysis for age, gender, ethnicity, body mass index, and duration of diabetes. When they adjusted for these factors, they found that the likelihood of insulin use only and diet only as diabetes treatment declined from NHANES III to NHANES 1999–2002, while the likelihood of OAD use only and OAD plus insulin use increased.
Multivariate analysis revealed no change in the likelihood of glycemic control between NHANESIIIand NHANES1999–2002.
“This trend does not improve the rates of cardiovascular, renal, and other diabetic complications that may have an impact on health care costs,” the researchers reported in their poster that was presented.
GlaxoSmithKline funded the study.