<b>OBJECTIVE</b>
There has
been a shift towards new classes of glucose lowering drugs (GLDs) in the past
decade but no improvements in glycemic control or hospitalization rates due to
severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs
utilization, glycemic control and SH rate among patients with diabetes in Hong
Kong which introduced a territory-wide, team-based diabetes care model since
2000.
<p><b>RESEARCH
DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes
Surveillance Database, we estimated age- and sex-standardized proportion of GLDs
classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes
patients aged≥20 years between 2002-2016. </p>
<p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to
35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4
inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with
HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH
rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The
main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean
(SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001).
The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising
proportions not on GLDs (from 2.0% to 7.7%).</a></p>
<p><b>CONCLUSIONS</b>
In this 15-year survey, the modest but important improvement in HbA1c since
2007 coincided with diabetes service reforms, increase in metformin, decrease
in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic
control and under-utilization of GLDs in the youngest group calls for targeted action.</p>
Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016