Personalized type 2 diabetes treatment in primary care: insights using real world data

The thesis focuses on personalized treatment among people with type 2 diabetes (T2D) in primary care. Given recommendations for less strict glycated haemoglobin A1c (HbA1c) and systolic blood pressure (SBP) levels in older and frail patients, we studied the HbA1c and SBP levels at initiation of glucose- and blood pressure-lowering medication between 2007 and 2020. Surprisingly, no significant differences according to age or frailty were observed in these trends. In another observational study, we found that when treated with antihypertensives the occurrence of hypotension-related adverse events was higher in older patients, those with polypharmacy and those with lower SBP levels, illustrating the need for personalized treatment. Next, we explored sex differences in the quality of medication prescribing. Among those treated with medication, females less often received metformin, renin-angiotensin-aldosterone inhibitors, and statins. Moreover, statin treatment was initiated less often among females than males. In another study, we observed that females with T2D had significantly lower low-density lipoprotein (LDL) cholesterol levels at younger ages and higher LDL cholesterol levels after the age of 50 years when compared to males, indicating a potential need for sex-specific treatment recommendations. Finally, we studied patients' willingness to engage in different treatments to manage T2D, including healthy eating, physical activity, and medication. Most patients were willing to engage in either of these but only half were willing to engage in all three options. Overall, we identified several areas of T2D treatment that may not be sufficiently personalized and need more attention in clinical practice and future research.