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Diabetics Have Worsening Blood Sugar Control

Diabetics Have Worsening Blood Sugar Control

(Copyright DPC)

Monday, 17 October 2016 08:04 AM

The number of U.S. diabetics with healthy blood sugar levels has declined in recent years, a recent study suggests.

Researchers analyzed data on 1.6 million adults with diabetes from 2006 to 2013. During this period, the proportion with healthy blood sugar levels declined from 56 percent to 54 percent, and the share with dangerously elevated blood sugar rose from 10 percent to 12 percent.

"Clearly, there is a sizeable proportion of patients with poor glycemic control - and many of them are young," said lead study author Kasia Lipska of Yale University in New Haven, Connecticut. "We need to do better for them."

Globally, about one in nine adults have diabetes, and the disease will be the seventh leading cause of death by 2030, according to the World Health Organization.

Most of these people have type 2 diabetes, which is linked to obesity and aging. When the disease isn't properly treated, their bodies can't process certain foods and excess sugars accumulate in the blood.

Medication can help people with diabetes keep blood sugar in a healthy range, as can changes in diet and exercise habits.

For the current study, researchers examined data on prescriptions and blood sugar test results to see how changes in medication utilization might relate to shifts in the proportion of diabetics with healthy blood sugar.

Use of one family of medicines - thiazolidinediones - plummeted from 2006 to 2013 when one drug in this class, Avandia (known generically as rosiglitazone) was linked to an increased risk of heart attack, stroke and congestive heart failure. Thiazolidinedione prescriptions accounted for less than 6 percent of the market share for diabetes drugs by the end of the study period, down from 29 percent at the start.

Prescriptions also fell for a class of older diabetes drugs known as sulfonylureas. These medicines - which include Micronase (glyburide), for example - accounted for 31 percent of prescriptions at the end of the study, down from 39 percent.

A family of medicines introduced around the start of the study period called DPP-4 inhibitors, meanwhile, accounted for 15 percent of prescriptions by 2013. (These drugs include sitagliptin, saxagliptin and vildagliptin, for example.)

Prescriptions for an older generic drug, metformin, rose from 48 percent to 54 percent over the course of the study.

 

The study didn't explore why shifts in drug utilization or changes in blood sugar control occurred, but it's possible at least some patients were using less effective medicines by the end of the study, Lipska said by email.

"Many of the newer medications have the advantages of not causing weight gain or (dangerously low blood sugar), however, some are not as potent in lowering blood sugar levels as many of the older medications," Lipska said.

"In addition, just because medications are available and put into use doesn't mean that they are necessarily applied in ways that improve care," Lipska added.

One limitation of the study is its focus on people with private insurance or Medicare who may be more likely to take expensive newer medicines than uninsured patients, the authors note in Diabetes Care.

Another drawback is that researchers only had blood sugar data for about 25 percent of the people in the study, noted Dr. David Nathan, director of the Massachusetts General Hospital Diabetes Center in Boston.

"Other data have suggested a major improvement in diabetes control over the past 20 years," Nathan, who wasn't involved in the study, said by email.

Recently, however, despite the introduction of new drugs, improvement in blood sugar control has leveled out, Nathan said. "The new medicines are substantially more expensive without obvious benefits."

With so many drugs to choose from, it's also possible people are overlooking the role of diet and exercise in managing the disease, said Dr. William Herman, a researcher at the University of Michigan in Ann Arbor who wasn't involved in the study.

"Obesity and lack of focus on diet and physical activity may certainly be contributing to the lack of improvement in blood sugar control," Herman said by email.

 

 

© 2020 Thomson/Reuters. All rights reserved.

   
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The number of U.S. diabetics with healthy blood sugar levels has declined in recent years, a recent study suggests.Researchers analyzed data on 1.6 million adults with diabetes from 2006 to 2013. During this period, the proportion with healthy blood sugar levels declined...
U.S., diabetics, worsening, blood, sugar, control
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2016-04-17
Monday, 17 October 2016 08:04 AM
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