Abstract
AIMS: While glycemic control is key in effective type 2 diabetes mellitus management, many patients fail to reach their individualized glycemic goal. This analysis aimed to describe a real-world picture of diabetes management: individualized hemoglobin A(1c) (HbA(1c)) goals, rate of goal attainment, HbA(1c) at each line of therapy, and patient awareness of their glycemic goal. Secondly, we aimed to understand physician satisfaction with HbA(1c) amongst patients aware vs. those unaware of HbA(1c) goal. METHODS: Analysis of physicians and the next ten consulting patients with type 2 diabetes mellitus conducted in Europe and the USA including medical record data abstraction/assessment by physicians, a patient-reported survey and a physician survey. Patients were diagnosed for 3 months or more with a known current and target HbA(1c). For the sub-analysis assessment of patient awareness of HbA(1c) goal, in addition to the above, these patients had to have completed a patient-reported questionnaire and answer the question on awareness of HbA(1c) goal. RESULTS: A total of 730 physicians provided data on 8794 patients with type 2 diabetes mellitus; 5331 patients were eligible for this analysis. Overall, mean (standard deviation, SD) individualized HbA(1c) goal was 6.8% (0.68%). Of eligible patients, 39.1% met their HbA(1c) goal; of 60.9% of patients not reaching their HbA(1c) goal, the mean distance from individualized HbA(1c) goal was 0.9% (SD 1.0%). Physicians progressed patients' antihyperglycemic therapy when HbA(1c) was 8% or higher. Among 2560 patients who were included in the sub-analysis assessing the effect of patient awareness of their HbA(1c) goal on multiple parameters, 70.5% were aware of their HbA(1c) goal; mean HbA(1c) goal was 6.8% (0.7%) and current mean HbA(1c) value 7.1% (1.2%). A total of 949 patients in the sub-analysis (39.2%) achieved their goal; achieving HbA(1c) goal was not related to knowledge of goal. Patients aware of their HbA(1c) goal were slightly more adherent to their antihyperglycemic medication. They also were prescribed more antihyperglycemic agents, more often on a later therapy line receiving a GLP-1 receptor agonist, SGLT2i, or insulin, and more often tested their blood glucose levels than patients who were unaware. Physicians were not satisfied with the current blood glucose level of one third of their patients, believing that more of those who were aware of their HbA(1c) goal could achieve better glucose control (32.4% of aware vs. 28.2% of unaware patients; p = 0.003). CONCLUSIONS: Our results showed that the proportion of patients with type 2 diabetes mellitus achieving their goals for glycemic control was suboptimal when compared to current guideline criteria, with only about 40% of patients achieving their individualized HbA(1c) goal. Treatment intensification was often delayed until HbA(1c) was 8% and higher. Patients aware of their HbA(1c) goal were slightly more adherent to their antihyperglycemic medication; however, awareness of HbA(1c) goal did not enhance goal attainment. This highlights the need for a holistic approach to diabetes management, involving patient education, and patient-physician communication and partnership.