Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER

Abstract

Introduction: J-DISCOVER is a prospective, observational cohort study that aimed to understand characteristics, glycaemic control, comorbidities and real-world management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, by enrolling patients initiating second-line treatment from both diabetes specialist and non-specialist care settings.

Methods: As part of the global DISCOVER programme, J-DISCOVER enrolled 1798 patients with T2DM aged at least 20 years old from 142 sites across Japan, from September 2014 to December 2015, and followed these patients for 3 years. Glycaemic control, body mass index (BMI), blood pressure, lipid profiles, treatment patterns, and prevalence of CKD and retinopathy were examined from baseline to 6, 12, 24 and 36 months, stratified by class of second-line treatment.

Results: At baseline, the median time after T2DM diagnosis was 3.1 years and mean glycated haemoglobin (HbA1c) was 7.7%. The mean individualized HbA1c target was 6.7 ± 0.5%, and 55.3% of patients were set the target of < 7.0%. HbA1c reductions were noted from 6 months and mean HbA1c was 7.1% at 36 months. The proportion of patients with HbA1c < 7.0% increased from 28.8% at baseline to 53.3% at 36 months, and the achievement rate of individualized HbA1c targets increased from 6.1% to 30.3%. Only two cases of severe hypoglycaemia occurred during the study. No major changes in BMI, blood pressure, lipid profile or prescription of antihypertensive or dyslipidaemia medications were observed. The frequencies of screening to detect retinopathy and chronic kidney disease (CKD) were 17.0-21.0% and 14.5-16.0%, respectively, during the follow-up period. The prevalence of CKD, but not retinopathy, increased over the follow-up period.

Conclusions: This study provided an overview of the 3-year management of early-stage T2DM in patients initiating second-line treatment. Contemporary management improved glycaemic control with an acceptable risk-benefit balance, although hurdles remain to sufficient implementation of guideline-recommended treatments in current clinical practice.

Trial registration: ClinicalTrials.gov identifier, NCT02226822.

Keywords: Antidiabetic drugs; Diabetes complications; Glycaemic control; Second-line treatment; Type 2 diabetes mellitus.

© 2021. The Author(s).

Figures

Fig. 1

Distribution of individualized HbA1c targets at baseline. n denotes the number of patients who have relevant data available. α-GI alpha-glucosidase inhibitor, BG biguanide, DPP4i dipeptidyl peptidase 4 inhibitor, GLP-1RA glucagon-like peptide 1 receptor agonist, HbA1c glycated haemoglobin, SGLT2i sodium–glucose cotransporter 2 inhibitor, SU sulfonylurea, TZD thiazolidinedione

Fig. 2

Mean HbA1c by second-line treatment. Whiskers represent standard deviations. n denotes the number of patients who have relevant data available. α-GI alpha-glucosidase inhibitor, BG biguanide, DPP4i dipeptidyl peptidase 4 inhibitor, GLP-1RA glucagon-like peptide 1 receptor agonist, HbA1c glycated haemoglobin, SGLT2i sodium–glucose cotransporter 2 inhibitor, SU sulfonylurea, TZD thiazolidinedione

Fig. 3

Proportions of patients who achieved A HbA1c < 7.0% and B individualized targets. n denotes the number of patients who have relevant data available. α-GI alpha-glucosidase inhibitor, BG biguanide, DPP4i dipeptidyl peptidase 4 inhibitor, GLP-1RA glucagon-like peptide 1 receptor agonist, HbA1c glycated haemoglobin, SGLT2i sodium–glucose cotransporter 2 inhibitor, SU sulfonylurea, TZD thiazolidinedione

Fig. 4

Proportions of patients with available screening data for CKD and retinopathy. n denotes the total number of patients, except for consultation by ophthalmologist (for which n denotes the number of patients for whom microvascular complications were investigated)