Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes

Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in [HbA.sub.1C], as the difference between the pre-treatment [HbA.sub.1C] (within 3months before OAD initiation) and the post-treatment [HbA.sub.1C] (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3months in [HbA.sub.1C] and categorized by the median decline into levels of steep [[greater than or equal to]9 mmol/mol ([greater than or equal to]0.8%)] and flat decline [