{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:25:13Z","timestamp":1740126313909,"version":"3.37.3"},"reference-count":19,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,10,4]],"date-time":"2018-10-04T00:00:00Z","timestamp":1538611200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["513781","1042231"],"award-info":[{"award-number":["513781","1042231"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pharmacotherapy and supportive care for diabetes in Australia are improving, with potential beneficial effects on therapeutic procrastination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine whether glycaemic thresholds for therapeutic intensification in type 2 diabetes changed over the 15 years between phases of the community\u2010based Fremantle Diabetes Study (FDS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 531 Phase 1 participants (mean age 62.4 years, 54.2% males, median diabetes duration 3.0 years) with valid data from baseline assessment and five subsequent annual reviews between 1993 and 2001 and 930 Phase 2 participants (mean age 65.3 years, 53.8% males, median diabetes duration 8.0 years) with valid data from baseline and two subsequent biennial reviews between 2008 and 2015. The main outcome measure was HbA<jats:sub>1c<\/jats:sub> at assessments before and after change in blood glucose\u2010lowering therapy (average 6 months in Phase 1, 12 months in Phase 2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010seven participants in Phase 1 and 84 in Phase 2 progressed from diet\u2010based management to oral hypoglycaemic agents (OHA) and 45 and 85 participants, respectively, progressed from diet\/OHA to insulin. The median HbA<jats:sub>1c<\/jats:sub> was 7.5% (58 mmol\/mol) and 6.9% (52 mmol\/mol) before OHA initiation in Phases 1 and 2, respectively, and 9.1% (76 mmol\/mol) and 7.8% (62 mmol\/mol), respectively, before insulin initiation. There were median HbA<jats:sub>1c<\/jats:sub> falls of 0.3% (3 mmol\/mol) and 1.5% (16 mmol\/mol) after OHA and insulin initiation in Phase 1, but no statistically significant changes in Phase 2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HbA<jats:sub>1c<\/jats:sub> thresholds triggering treatment intensification fell between FDS phases, suggesting a more proactive approach to management of glycaemia over time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.13710","type":"journal-article","created":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T08:43:05Z","timestamp":1513068185000},"page":"1215-1221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal changes in glycaemic thresholds for treatment intensification in type 2 diabetes in an urban Australian setting: the Fremantle Diabetes Study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0749-7411","authenticated-orcid":false,"given":"Timothy M. 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