Current Level of Glycaemic Control and Its Associated Factors in Patients With Type 2 Diabetes Across Europe

Data From the PANORAMA Study

Pedro de Pablos-Velasco; Klaus G Parhofer; Clare Bradley; Eveline Eschwège; Linda Gönder-Frederick; Pierre Maheux; Ian Wood; Dominique Simon

Disclosures

Clin Endocrinol. 2014;80(1):47-56. 

In This Article

Abstract and Introduction

Abstract

Objective To provide an update on glycaemic control in European patients with type 2 diabetes based on data from the nine-country, cross-sectional PANORAMA study (NCT00916513).

Design Post-hoc analysis to report the number of patients achieving/not achieving glycaemic goal (HbA1c <7%).

Patients Patients were randomly or consecutively selected from physician practices in nine countries. Eligible patients were aged ≥40 years, diagnosed with type 2 diabetes >1 year prior to study entry, and had an available medical record of >1 year.

Measurements All data were collected at a single visit, including HbA1c measurement using a common device (A1CNow®). Bivariate and multivariate analyses were used to investigate factors associated with not reaching glycaemic goal.

Results Of 5817 patients enrolled (aged 65·9 ± 10·4 years, 53·7% male), 37·4% had an HbA1c ≥7%; (range 25·9% in The Netherlands to 52·0% in Turkey). In adjusted multivariate analyses, higher individual glycaemic target, younger age, poor physician-reported patient adherence to lifestyle/medication, longer diabetes duration, increasing treatment regimen complexity and physician-reported patient's unwillingness to intensify treatment were associated with not achieving goal. However, bivariate analyses also found gender, socioeconomic factors, body mass index, rate of complications and hypoglycaemia to be associated with not achieving goal.

Conclusions In PANORAMA, 37·4% of patients enrolled were not at glycaemic goal. Factors relating to patient characteristics, physician selection of individualized HbA1c target and diabetes itself (longer duration, more complex treatment) were strongly associated with not achieving goal. Further studies are warranted to explore these associations and evaluate strategies for improving glycaemic control.

Introduction

Clear guidelines for good glycaemic control have been developed in North America and Europe recommending a glycated haemoglobin (HbA1c) goal of <7% [53 (mmol/mol)] for most adults with type 2 diabetes.[1] Guidelines from the American Association of Clinical Endocrinologists and the American College of Endocrinology support the use of individualized treatment regimens based on the presenting HbA1c in treatment-naïve patients or the current HbA1c in treated patients, along with numerous other patient-specific factors, and they stress the need to advance therapy if the HbA1c goal is not met within 3 months.[2] These guidelines are based on evidence from a number of trials in type 2 diabetes showing that greater glycaemic control provided benefits in reducing microvascular complications.[3,4]

Nevertheless, despite stricter treatment guidelines and an observed trend towards better control, many patients are still not achieving glycaemic goals.[5] In Europe, most studies assessing the degree of diabetes control have been conducted at a national level.[6–9] The Cost of Diabetes in Europe - Type 2 (CODE-2) study evaluated glycaemic control, blood lipid levels and blood pressure, and its treatment, in a large group of patients with type 2 diabetes in Europe.[10] This study showed that a high proportion of patients with risk factors for diabetes-related complications were not adequately controlled, with just 31% of patients achieving good glycaemic control (given as HbA1c ≤6·5%).[10] The CODE-2 study was conducted 10 years ago and while subsequent studies have proved to be informative, they have focused on specific treatment options (IMPROVE),[11] specialized patient populations and particular countries (UK Prospective Diabetes Study Group 1998),[12] or have not included treatment information (EUROASPIRE).[13,14] Clearly, an update on glycaemic control in the general clinic population of patients with type 2 diabetes in Europe and an accurate assessment of the reasons why treatment goals are not achieved is needed.

PANORAMA is a large, nine-country, observational, cross-sectional study (NCT00916513) of patients with type 2 diabetes, aimed at assessing treatment satisfaction, quality of life (QoL) and other patient-reported outcomes (PROs) in relation to glycaemic control and treatment patterns. It is hoped that the associated factors identified by PANORAMA will provide further insight and a different viewpoint for both clinicians and policymakers responsible for evaluating disease management strategies and their outcomes.

This current post-hoc analysis of data from the PANORAMA study examines the number of patients from eight European countries and Turkey not achieving glycaemic goal and relative contributions of demographic, clinical and treatment factors affecting glycaemic control. The analysis has been guided by a review of the primary data and secondary data (manuscripts currently in development), but is independent of these analyses due to the nature of the PANORAMA Study.

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