Glycemic Control Over 5 Years in 4,900 People With Type 2 Diabetes Real-world diabetes therapy in a clinical trial cohort

作者：Best James D^*; Drury Paul L; Davis Timothy M E; Taskinen Marja Riitta; Kesaniemi Y Antero; Scott Russell; Pardy Christopher; Voysey Merryn; Keech Anthony C

来源：Diabetes Care, 2012, 35(5): 1165-1170.

DOI：10.2337/dc11-1307

OBJECTIVE-Glycemic control in type 2 diabetes generally worsens over time, requiring intensification of therapy. The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial provided the opportunity to observe glycemic control in a real-world setting. We assessed the adequacy of metformin, sulfonylureas, and insulin to maintain glycemic control and their effects on weight. %26lt;br%26gt;RESEARCH DESIGN AND METHODS-Diabetes control was measured at baseline and yearly for a median of 5 years in the 4,900 patients from the nonintervention arm of this study allocated to placebo. %26lt;br%26gt;RESULTS-Median HbA(1c) was 6.9% at baseline and increased by an average of 0.22% over 5 years (P %26lt; 0.001). Median weight was 86.3 kg at baseline and decreased by 0.4 kg over 5 years (P = 0.002). Baseline therapy was lifestyle measures only in 27%, oral agents without insulin in 59%, and insulin in 14% (7% also taking oral agents). Over 5 years, insulin use increased to 32% (21% also taking oral agents). Use of oral agents remained similar at 56%. Only 2% of patients at baseline and 4% after 5 years were taking oral agents other than metformin or sulfonylureas. Initiation of insulin therapy in 855 patients produced a sustained reduction of HbA(1c) from a median of 8.2 to 7.7%, with a weight gain of 4.6 kg over 5 years. %26lt;br%26gt;CONCLUSIONS-With intensification of traditional therapies, glycemic control deteriorated very little over 5 years in a large cohort of type 2 diabetes. However, the requirement for insulin therapy doubled, at the expense of significant weight gain and risk of hypoglycemia.

• 出版日期2012-5