This PhD thesis, conducted by our esteemed colleague Martina Ambrož, PhD, explores the personalized treatment of type 2 diabetes using real-world data. It investigates trends in glycated hemoglobin A1c and systolic blood pressure levels, medication prescribing disparities, and the willingness of patients for different management options. The findings underscore the importance of tailored approaches for optimizing T2D management.
The focus of this thesis is on personalized treatment for individuals with type 2 diabetes (T2D) in primary care. We conducted studies examining the levels of glycated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) at the initiation of glucose- and blood pressure-lowering medication between 2007 and 2020, considering the recommendations for less strict HbA1c and SBP levels in older and frail patients. Surprisingly, we found no significant differences in these trends based on age or frailty, suggesting a lack of personalized treatment in this regard.
In another observational study, we discovered that older patients, those with polypharmacy, and individuals with lower SBP levels had a higher occurrence of hypotension-related adverse events when treated with antihypertensives. This finding emphasizes the necessity for personalized treatment approaches. Furthermore, we investigated sex differences in the quality of medication prescribing. Among individuals receiving medication, we found that females were less likely to be prescribed metformin, renin-angiotensin-aldosterone inhibitors, and statins. Additionally, statin treatment was initiated less frequently in females compared to males. In a separate study, we observed that females with T2D had significantly lower low-density lipoprotein (LDL) cholesterol levels at younger ages but higher LDL cholesterol levels after the age of 50, indicating a potential need for sex-specific treatment recommendations.
Lastly, we examined patients’ willingness to engage in various treatments for managing T2D, including healthy eating, physical activity, and medication. While most patients expressed a willingness to pursue any of these options individually, only half of them were open to engaging in all three. This suggests that treatment preferences may vary among patients and underscores the importance of tailoring treatment plans to individual needs.
Overall, our findings highlight several areas in the treatment of T2D that may require greater personalization and warrant further attention in clinical practice and future research.