Initial monotherapy with either metformin or sulphonylureas often fails to achieve or maintain current glycaemic goals in patients with Type 2 diabetes in UK primary care

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Abstract
Aims  To describe initial achievement of glycaemic targets and subsequent hyperglycaemia in patients with Type 2 diabetes managed with oral agent monotherapy in UK primary care from 1998 to 2004.Methods  Electronic medical records of patients initiating metformin (n = 3362) or a sulphonylurea agent (n = 3070) in 290 UK primary care practices were retrieved from the General Practice Research Database (GPRD). Patients included had an HbA1c recorded 0–90 days before and 90–365 days after initiating monotherapy. The probability of achieving glycaemic thresholds in the first year, and for those achieving such targets, the probability of inadequate glycaemic control (HbA1c > 6.5%, > 7.0%, > 7.5%) over time is described.Results  Low baseline HbA1c and drug initiation within 3 months of diabetes diagnosis were the strongest predictors of initial achievement of glycaemic targets. The proportion of patients with diabetes duration ≥ 4 months who achieved HbA1c < 7% in the first year ranged from 24% to 88% for highest to lowest baseline HbA1c category in sulphonylurea initiators and from 19% to 86% in metformin initiators, with slightly higher proportions for newly diagnosed patients. Kaplan–Meier analyses suggested that 55% and 70% of patients who initially achieved glycaemic targets had HbA1c measurements above these targets at 2 and 3 years.Conclusions  Many patients fail to achieve glycaemic goals with initial monotherapy and, of those who achieve current goals, few consistently maintain these targets over 3 years. Research is needed to evaluate whether more aggressive treatment or alternative treatments can improve the long‐term maintenance of glycaemic control in patients with Type 2 diabetes.