Secondary Failure Following Initial Success of Metformin 二甲双胍继发失效后的初步成功.ppt

Secondary Failure Following Initial Success of Metformin 二甲双胍继发失效后的初步成功.ppt

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Secondary Failure Following Initial Success of Metformin 二甲双胍继发失效后的初步成功

Diabetes Medication: Initiation and Intensification Gregory A. Nichols, PhD Annual Collaborative Diabetes Education Conference for Health Professionals January 21, 2012 The Need for Diabetes Pharmacotherapy Diabetes is a metabolic condition characterized by hyperglycemia Insulin Resistance Insufficient insulin production Progressive, typically requiring ongoing therapy intensification General Benefits of Metformin Reduces hepatic glucose production in the presence of insulin At least weight neutral May be cardioprotective May reduce cancer risk Definitely prevents/delays diabetes in some at-risk individuals Metformin Initiation at Diabetes Diagnosis Recommended by EASD/ADA Does early vs. late metformin initiation and more intensive dosing: Increase the likelihood of successful metformin therapy? Prolong its success? Study Site and Sample Selection Kaiser Permanente Northwest All diabetes patients who initiated metformin monotherapy as first-ever anti-hyperglycemic drug, 2004-2006 Members for 1 year pre- and 6 months post-metformin initiation HbA1c measured pre- and post-metformin initiation Characteristics of Patients Who Did and Did Not Achieve A1C 7% Characteristics of Patients Who Did and Did Not Achieve A1C 7% Factors Associated with Probability of Attaining A1C 7% A1C at Metformin Initiation and Probability of Attaining A1C 7%* Best A1C Achieved by A1C at Metformin Initiation Diabetes Duration and Probability of Attaining A1C 7%* Best A1C Achieved by Diabetes Duration at Metformin Initiation Definitions of Secondary Failure Added/switched to another anti-hyperglycemic agent Subsequent HbA1c 7.5% Composite of the above Sample Characteristics Probability of Secondary Failure Secondary Failure of Metformin by HbA1c at Initiation Secondary Failure of Metformin by Diabetes Duration at Initiation Summary In KPNW clinical practice, 72% of drug na?ve patients attained the goal of A1C7% After attaining goal, metformin monotherapy secondary failure rates

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