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Initiation, intensification of insulin treatment aids in glycemic control
Starting or intensifying an insulin dosing regimen may lower HbA1c, helping to achieve glycemic targets in patients with inadequately controlled type 2 diabetes, according to a study published in BMJ Open Diabetes Research & Care.
“Despite an availability of a range of pharmacological agents and the stepwise approach to type 2 diabetes treatment advocated by [the] ADA/EASD position statement, many patients with type 2 diabetes remain in poor glycemic control for prolonged periods of time,” Abdulqawi Al Mansari, MD, of the department of endocrinology at Erfan Hospital in Saudi Arabia, and colleagues wrote. “The aim of the present study was to assess the clinical and nonclinical predictive factors for achieving the glycemic goal HbA1c as targeted by the treating physician in adults with type 2 diabetes requiring insulin initiation, titration and/or intensification.”
Researchers conducted a 12-month real-world practice, multicenter, noninterventional, noncomparative study of 2,704 adults with inadequately controlled type 2 diabetes (mean age, 54.6 years; 53.5% men; 48.8% South Asian; mean BMI, 28.7 kg/m2; mean HbA1c, 9.7%). A diabetes-related cardiovascular complication was identified in 55.9% of participants (a median of 14.6% had a 10-year coronary heart disease risk rate, and most had uncontrolled BP). The study took place from October 2012 to January 2015 in 10 developing countries.
Participants had four clinical visits scheduled — at baseline and at 3, 6 and 12 months of follow-up —in which physicians recorded visit data and patients filled out questionnaires that included demographic and socioeconomic characteristics, relevant medical history about diabetes complications, CV risk factors and glycemic control.
Patients either initiated a basal insulin therapy with insulin glargine, switched to insulin glargine, added insulin glulisine to basal insulin or initiated a new insulin dosing regimen with insulin glargine and insulin glulisine from premixed insulin.
Considering both clinical variables (such as age, ethnicity, history of diabetes, history of diabetes-related complications, baseline HbA1c and insulin use) and nonclinical variables (related to diabetes education, frequency of HbA1c measurement and health coverage), researchers performed univariate and multivariate logistic regression analyses to identify clinical and nonclinical predictive factors for achieving a physician-targeted glycemic goal at 6 and 12 months (the target was HbA1c < 7% for 25.8% of patients and 7% to 7.5% for the remaining participants).
Researchers found that older age; white, Asian, Arab or Persian ethnicity; shorter duration of diabetes; and lower baseline HbA1c predicted the ability to achieve glycemic targets. The combination therapy of more than two oral antidiabetes drugs and the use of analogue insulin were predictors of poor glycemic control.
Researchers also found that after 6 and 12 months of treatment, there was a mean absolute reduction in HbA1c from baseline of –1.7% (95% CI, –1.7 to –1.6) and –2% (95% CI, –2.1 to –2), respectively. Furthermore, 29.7% of patients had achieved HbA1c target of less than 7% at 12 months vs. 19% at 6 months. Overall, 98% of patients with a lower HbA1c goal achieved their target by the end of the study.
“It appears necessary to treat early with insulin and intensify the treatment so that a large number of patients reach an optimal glycemic level, decreasing the risk for CVD,” the researchers wrote. – by Melissa J. Webb
Disclosures: The study and data analysis was sponsored by Sanofi. The authors report no relevant financial disclosures.