Second-line agents for glycemic control for type 2 diabetes

Are newer agents better?

Yuanhui Zhang, Rozalina McCoy, Jennifer E. Mason, Steven A. Smith, Nilay D Shah, Brian T. Denton

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: While metformin is generally accepted as the first-line agent in treatment of type 2 diabetes, there are insufficient evidence and extensive debate about the best second-line agent. We aimed to assess the benefits and harms of four commonly used antihyperglycemia treatment regimens considering clinical effectiveness, quality of life, and cost. RESEARCH DESIGN AND METHODS: We developed and validated a new population-based glycemic control Markov model that simulates natural variation in HbA1c progression. The model was calibrated using a U.S. data set of privately insured individuals diagnosed with type 2 diabetes. We compared treatment intensification of metformin monotherapy with sulfonylurea, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, or insulin. Outcome measures included life-years (LYs), quality-adjusted life-years (QALYs), mean time to insulin dependence, and expected medication cost per QALY from diagnosis to first diabetes complication (ischemic heart disease,myocardial infarction, congestive heart failure, stroke, blindness, renal failure, amputation) or death. RESULTS: According to our model, all regimens resulted in similar LYs and QALYs regardless of glycemic control goal, but the regimen with sulfonylurea incurred significantly lower cost per QALY and resulted in the longest time to insulin dependence. An HbA1c goal of 7% (53 mmol/mol) produced higher QALYs compared with a goal of 8% (64 mmol/mol) for all regimens. CONCLUSIONS: Use of sulfonylurea as second-line therapy for type 2 diabetes generated glycemic control and QALYs comparable with those associated with other agents but at lower cost. Amodel that incorporates HbA1c and diabetes complications can serve as a useful clinical decision tool for selection of treatment options.

Original languageEnglish (US)
Pages (from-to)1338-1345
Number of pages8
JournalDiabetes Care
Volume37
Issue number5
DOIs
StatePublished - 2014

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Quality-Adjusted Life Years
Type 2 Diabetes Mellitus
Costs and Cost Analysis
Metformin
Quality of Life
Diabetes Complications
Insulin
Dipeptidyl-Peptidase IV Inhibitors
Therapeutics
Blindness
Amputation
Renal Insufficiency
Myocardial Ischemia
Research Design
Heart Failure
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Second-line agents for glycemic control for type 2 diabetes : Are newer agents better? / Zhang, Yuanhui; McCoy, Rozalina; Mason, Jennifer E.; Smith, Steven A.; Shah, Nilay D; Denton, Brian T.

In: Diabetes Care, Vol. 37, No. 5, 2014, p. 1338-1345.

Research output: Contribution to journalArticle

Zhang, Yuanhui ; McCoy, Rozalina ; Mason, Jennifer E. ; Smith, Steven A. ; Shah, Nilay D ; Denton, Brian T. / Second-line agents for glycemic control for type 2 diabetes : Are newer agents better?. In: Diabetes Care. 2014 ; Vol. 37, No. 5. pp. 1338-1345.
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