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| |  Standard Treatment of Type 2 Diabetes With Metformin, Sulphonylurea, and Insulin Maintains Target Blood Glucose Level for 5 Years: Presented at EASD By Bruce Sylvester VIENNA, Austria -- October 6, 2009 -- In a large study of people with type 2 diabetes, standard care with metformin, sulphonylurea, and insulin effectively maintained haemoglobin (Hb) A1C (a measure of blood glucose), reported Australian researchers here at the 45th Annual Meeting of the European Association for the Study of Diabetes (EASD). “Median Hb A1C was maintained close to 7% for >5 years in a cohort of >4,000 patients with type 2 diabetes, widely distributed across 3 countries,” said James Best, MD, University of Melbourne, Melbourne, Australia, on October 2. 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 glycaemic 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 glycaemic 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 Hb A1C 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 glycaemic benefits of new therapies for type 2 diabetes should be assessed against what is achievable with standard and widely available current therapy. An Hb A1C target of <7% is achievable at a type 2 diabetes population level.” Funding for the study was provided by Laboratories Fournier. [Presentation title: Metformin, Sulphonylurea and Insulin Therapies Maintain Glycaemic Control Over Five Years in 4900 People With Type 2 Diabetes. Abstract 211]
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