Predictors of HbA1c treatment response to add-on medication following metformin monotherapy: a population-based cohort study

• Published in: Scientific reports Vol. 13; no. 1; p. 20891
• Main Authors: Tan, Wei Ying, Hsu, Wynne, Lee, Mong Li, Tan, Ngiap Chuan
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 28-11-2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/163/2743; 692/308; 692/699/317; Angiotensin; Angiotensin II; Antidiabetics; Beta blockers; Cholesterol; Cohort analysis; Creatinine; Diabetes; Diabetes mellitus (non-insulin dependent); Electronic medical records; Epidermal growth factor receptors; Glomerular filtration rate; High density lipoprotein; Humanities and Social Sciences; Hypertension; Metformin; multidisciplinary; Patients; Population studies; Primary care; Science; Science (multidisciplinary); Sodium-glucose cotransporter
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-47896-x

Evidence on the influence of patient characteristics on HbA
1c
treatment response for add-on medications in patients with type 2 diabetes (T2D) is unclear. This study aims to investigate the predictors of HbA
1c
treatment response for three add-on medications (sulfonylureas (SU), dipeptidyl peptidase-4 (DPP-4) and sodium–glucose cotransporter-2 (SGLT-2) inhibitor) in metformin monotherapy treated patients with T2D. This retrospective cohort study was conducted using the electronic health record data from six primary care clinics in Singapore. A total of 9748 adult patients with T2D on metformin monotherapy receiving SU, DPP-4 or SGLT-2 add-on were 1:1 propensity score matched to patients receiving other add-on medications. Patient demographics, laboratory results, diabetes related complications, comedications, and treatment response at two endpoints (HbA
1c
reduction ≥ 1% at 6th month, HbA
1c
goal attainment < 7% at 12th month) were examined. Multiple logistic regression analyses were used to identify patient characteristics associated with the treatment responses. After matching, there were 1073, 517, and 290 paired cohorts of SU, DPP-4 and SGLT-2 respectively. Besides baseline HbA
1c
, patients with longer hypertension disease duration and higher cholesterol HDL were associated with better treatment response to SU medication add-on. Lower estimated glomerular filtration rate (eGFR), and angiotensin-II receptor medications were associated with better treatment response to DPP-4 add-on. Lower cholesterol HDL, higher creatinine serum, absence of renal complications and beta-blockers medications were associated with better treatment response to SGLT-2 add-on. The cholesterol HDL, creatinine serum, eGFR, hypertension disease duration, angiotensin-II receptors and beta-blockers class of medications can influence the HbA
1c
treatment response for SU, DPP-4 and SGLT-2 add-on medications. Knowing the patients’ characteristics that influence treatment response can assist in guiding clinical decisions when selecting the appropriate add-on medication, ultimately helping to prevent the development of diabetes-related complications.