Treatment escalation and rise in HbA1c following successful initial XXXX therapy.

@entity1 @entity3916 @entity2449
OBJECTIVE: To describe secondary failure of initial @entity2449 therapy in @entity1 who achieved initial HbA(1c) ( @entity3916 ) <8% and to identify predictors of failure. RESEARCH DESIGN AND METHODS: We identified 1,288 @entity1 who achieved @entity3916 <8% within 1 year of initiating @entity2449 as their first-ever antihyperglycemic drug. Subjects were followed until they added/switched antihyperglycemics, they terminated health plan membership, or 31 December 2004. We defined secondary failure using two separate but overlapping approaches: 1) addition/switch to another antihyperglycemic drug or 2) first @entity3916 measurement >8.0% after at least 6 months on @entity2449 . RESULTS: The best @entity3916 achieved within 1 year of @entity2449 initiation was the most powerful predictor of avoiding secondary failure. Approximately 50% of subjects whose best @entity3916 was 7-7.9% added/switched antihyperglycemic drugs within 36 months, whereas it took >60 months for those in the 6-6.9% @entity3916 category to reach a 50% failure rate. Those who achieved an @entity3916 <6% did not reach a 50% rate of adding/switching drugs until 84 months. For the alternative secondary failure outcome, about half of those whose best @entity3916 was 7.0-7.9% reached an @entity3916 >8% within 24 months. Only approximately 25% of subjects in the 6-6.9% category failed by 48 months, and >80% of subjects in the <6% category remained below 8% through 60 months. CONCLUSIONS: Whether defined by adding/switching to another drug or by reaching an @entity3916 of 8%, secondary failure is inversely associated with the reduction of @entity3916 achieved within the 1st year of @entity2449 monotherapy.
