EASD: Treatment of Type 2 Diabetes with Metformin, Sulphonylurea, and Insulin Maintains Target for 5 Years

Median A1c was maintained close to 7% for more than 5 years in a cohort of more than 4,000 patients with Type 2 diabetes.

The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study aimed to determine whether a peroxisome proliferator-activated receptor alpha agonist, fenofibrate, would lower the risk of cardiovascular disease in patients with Type 2 diabetes. However, because FIELD was not aimed at modifying glycemic control or other aspects of diabetes care, the investigators had a chance to observe the efficacy of standard diabetes care in Australia, New Zealand, and Finland.

The FIELD investigators monitored glycemic control and diabetes management in a placebo-treated cohort of 4,900 subjects (aged 62 +-7 years, 37% women, median duration of diabetes 5 years) for 5 years.

Dr. Best reported that median Hb A1C was 6.9% at baseline and 7.0% by the end of the study (P < .0001). Median fasting glucose dropped to 7.9 mmol/L from the baseline of 8.5 mmol/L (P < .0001), and median weight fell to 85.0 kg from the baseline of 86.3 kg (P < .0001). At baseline, therapy for diabetes consisted of only lifestyle measures for 27% of the patients, oral agents for 67%, and insulin for 14%; 8% of the insulin-treated patients also took oral agents. During the 5-year period, insulin use increased to 28%, with 19% of the patients also taking oral agents. Use of oral agents was 77% at endpoint. The investigators noted that 2% of patients at baseline and 4% at 5 years were receiving any oral agents other than metformin or  sulphonylureas. Insulin treatment was initiated by 855 patients during the 5-year follow-up (representing 20% of those who were not taking insulin at baseline). Insulin initiation began at a median HbA1c of 8.2%, which was reduced to 7.6% at endpoint. Median weight at insulin initiation was 86.5 kg and increased by 4.6 kg. Dr. Best concluded, “This study demonstrates the effectiveness of current standard diabetes therapy — clinical care and medication — in countries with universal health insurance and primary care-led health systems.” He continued, “The glycemic benefits of new therapies for Type 2 diabetes should be assessed against what is achievable with standard and widely available current therapy. An HbA1c target of <7% is achievable at a Type 2 diabetes population level."

[Presentation title: Metformin, Sulphonylurea and Insulin Therapies Maintain Glycaemic Control Over Five Years in 4900 People With Type 2 Diabetes. Abstract 211]