DataSheet1_Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020.docx

Aims: We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends.
Materials and Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication.
Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60–69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70–79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p = 0.676). There were no differences in SBP thresholds between patients of different ages or sex.
Conclusion: The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.

研究目的：本研究旨在评估2型糖尿病患者启动降糖与降压药物治疗时，糖化血红蛋白A1c（HbA1c）与收缩压（SBP）阈值的变化趋势，并分析年龄与性别对上述趋势的影响。
材料与方法：本研究使用格罗宁根2型糖尿病治疗分析倡议（GIANTT）基层医疗数据库。纳入2015年至2020年间首次启动非胰岛素降糖药物治疗，或启动任意降压药物治疗，且在治疗前120天内完成HbA1c或SBP检测的2型糖尿病患者。本研究采用校正潜在混杂因素的多水平回归分析，以评估日历年份、年龄、性别，以及日历年份与年龄/性别的交互作用对药物启动时HbA1c与SBP阈值变化趋势的影响。
研究结果：本研究纳入的HbA1c阈值分析与SBP阈值分析的患者数量分别为2671例与2128例。降糖药物启动时的总体平均HbA1c阈值从2015年的7.4%显著升高至2020年的8.0%（p < 0.001），该升高趋势在较年轻的年龄组中尤为明显。与≥80岁的患者相比，60~69岁的患者主要在研究早期启动药物治疗时的HbA1c阈值更低。<60岁与70~79岁的患者启动药物治疗时的HbA1c阈值与≥80岁患者无显著差异。在整个研究周期内，女性患者启动药物治疗时的HbA1c阈值均低于男性患者（p < 0.001）。降压药物启动时的平均SBP阈值在145~149mmHg之间波动，无明确变化趋势（p=0.676）。不同年龄或性别的患者之间，SBP阈值无显著差异。
研究结论：较年轻年龄组中启动降糖药物治疗的HbA1c阈值呈升高趋势，这一结果出人意料，需开展进一步研究。男性患者启动降糖药物治疗的时机似乎晚于女性患者。近年来，高龄组患者未出现更高的药物启动HbA1c阈值，而年轻组患者也未出现更低的阈值，这与基于年龄的个性化糖尿病护理推荐指南不符，亟需卫生系统层面的干预措施。