International Comparison of Time to Treatment Intensification and Rates of Complications in Metformin Monotherapy Treated Type 2 Diabetes Patients
Notice bibliographique
Résumé
Type 2 diabetes mellitus is a progressive disease which affects many people in Canada and the United States, and the prevalence of type 2 diabetes is only expected to increase in the future. Pharmacological interventions are a cornerstone of the management of type 2 diabetes as they help to attain substantial and sustainable lowering of a patient’s blood glucose levels. Moreover, they contribute to enhancing a patient’s overall quality of life by reducing complications throughout the duration of this disease. In practice, type 2 diabetes patients in both Canada and the United States are managed according to clinical practice guideline (CPG) recommendations, which involve the utilization of metformin as a first line antihyperglycemic agent to bring blood glucose levels to a target level. Subsequent treatment intensification with other antihyperglycemic agents, including insulin, is often required when a patient’s blood glucose is no longer under control. A lack of glucose control or untimely intensification of drug therapy for type 2 diabetes patients can lead to major complications. The first objective of this research program was to determine if differences exist between the way that newly treated type 2 diabetes patients are managed in Canada and the United States. This was accomplished using a retrospective cohort of type 2 diabetes patients from Canada and the United States who were just starting antihyperglycemic therapy. The study period was 2004-2010. To ensure comparability, the cohorts were restricted to patients initiating guideline-recommended metformin monotherapy treatment as directed by the CPGs in the two countries. We then determined the time from the initiation of guideline-concordant antihyperglycemic therapy to the addition of a second antihyperglycemic agent. The results showed that patients in the United States are more likely to intensify drug therapy sooner than patients in Canada and at a lower hemoglobin A1c value. This suggests that although CPGs are similar between Canada and the United States, adherence to the guidelines may be different between the two countries and patients in Canada may have more clinical inertia compared to their United States counterparts with respect to antihyperglycemic drug changes. The second objective was to determine if there are differences between Canada and the United States in terms of the time from the initiation of type 2 diabetes treatment to any major diabetes-related complications. In this study, we retrospectively determined the time from the initiation of guideline-concordant metformin monotherapy to the first occurrence of macrovascular and microvascular complications of interest. Our results show that, for the most part, there are minimal differences in rates of complications between the countries; however, patients in the United States have higher rates of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) compared to patients in Canada. Collectively, our studies suggest that even though patients in the United States are experiencing intensification of type 2 diabetes treatment sooner and at a lower hemoglobin A1c level, there is minimal difference in the time from initiation of treatment to the incidence of macro- or microvascular complications in our population. Historically, the clinical benefits of timely treatment intensification have been shown; however, newer clinical trials suggest that the benefits of intensification may not be substantial. Thus, although the United States intensified treatments more quickly, the minimal difference in rates of complications is in line with current evidence on the role of blood glucose on major macrovascular and microvascular complications.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».