Early versus late intensification of glucose-lowering therapy in patients with type 2 diabetes: Results from the DISCOVER study

International audienceAims: To assess the effects of glycated haemoglobin (HbA(1c)) levels at time of glucose-lowering treatment intensification in DISCOVER, a global observational study of patients with type 2 diabetes (T2D) initiating second-line therapy. Outcomes of interest were glycaemic control, hypoglycaemia, and need for further intensification during 3 years of follow-up. Methods: We included patients who intensified treatment (add-on or insulin initiation) upon initiation of second-line therapy (baseline). Outcomes were assessed according to baseline HbA(1c): HbA(1c) <= 7.5% (early intensification) or HbA(1c) > 7.5% (late intensification). Factors associated with early or late intensification were assessed using multivariate logistic regression. Results: Of the 9575 patients included, 3275 (34.2%) intensified treatment early and 6300 (65.8%) intensified treatment late. During follow-up, mean (SD) HbA(1c) was lower in the early-than in the late-intensification group (6.9% [0.95%] vs 7.5% [1.28%] at 36 months). More patients had HbA(1c) < 7.0% in the early-than in the late-intensification group (61.8% vs 37.9% at 36 months; p < 0.001). The risk of further intensification was higher in the late-intensification group (hazard ratio 1.88 [95% confidence interval 1.68-2.09]). Occurrence of hypoglycaemia was similar in both groups. Conclusions: Late intensification of glucose-lowering therapy after first-line treatment failure reduces the likelihood of reaching recommended treatment goals