Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

Abstract

Background: The aim of the present study was to determine the clinical characteristics of patients with type 2 diabetes mellitus (T2DM) treated with basal insulin who achieved an adequate fasting plasma glucose (FPG) level (<130 mg/dL), but were unable to achieve the HbA1c target (<7%; <53 mmol/mol). Methods: A cross-sectional study was performed on T2DM patients aged 31-90 years treated with basal insulin registered in the SIDIAP Q primary healthcare electronic database during 2010. Results: In 2010, of a population of 126 811 T2DM subjects, 9899 were treated with basal insulin (neutral protamine Hagedorn [NPH], detemir, or glargine). Of these, 23.5% (n = 2322) achieved optimal FPG control levels (<130 mg/dL) but an inadequate HbA1c target (>7%). Mean HbA1c values in the contolled and uncontrolled groups were 8.15% (65.6 mmol/mol) and 6.31% (45.5 mmol/mol), respectively. Patients with controlled FPG but uncontrolled HbA1c had longer T2DM duration (11.6 vs 9.9 years), higher systolic blood pressure (138.2 vs 136.3 mmHg) and low-density lipoprotein cholesterol (104 vs 99 mg /dL), and a higher prevalence of retinopathy (24.8% vs 18.2%) than patients (17.8%) with optimal control of both glycemic targets (P < 0.05). Multivariate analysis showed that inadequate glycemic control was positively related only to younger age. Conclusion: One-quarter of T2DM patients treated with basal insulin have difficulties attaining the recommended HbA1c goal despite adequate FPG levels. As some guidelines state, healthcare professionals should focus on PPG to identify and intensify treatment to control prandial glucose excursions in these patients.

Clinical Predictors of the Need for Further Treatment Escalation in Patients with Type 2 Diabetes on Basal Insulin Therapy – A Retrospective Observational Study

“…In line with proportions reported to achieve HbA 1c values < 53 mmol/mol ( < 7.0 %) from treat-to-target trials [1-3, 23, 24], this percentage was 73 % or approximately three fourths of the total cohort in our study. This number corresponds well with published figures regarding "residual hyperglycaemia" (HbA 1c > 7.0 % or in patients achieving their fasting plasma glucose targets with basal insulin [25,26]. Our study clearly pinpoints the role of post-meal glycaemic excursions in explaining this discrepancy.…”

Renoprotective Effects of the Dipeptidyl Peptidase-4 Inhibitor Sitagliptin: A Review in Type 2 Diabetes

“…Current recommendations by the consensus of the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) justify the selection of appropriate treatment based on its capability to achieve and maintain desired glycaemic goals [ 36 – 38 ]. Despite all recomendations, many patients spend a long time well outside the target glycaemic range and, therefore, have an increased risk for developing micro- and macrovascular complications [ 6 , 39 ]. Currently, it is becoming clearer that T2DM management must envision not only glycaemic control but also and particularly, the mechanisms behind progression of pancreatic deterioration and evolution of diabetic complications [ 40 , 41 ].…”

When basal insulin is not enough: successful strategies for insulin intensification in patients with type 2 diabetes mellitus

“…Из этой когорты 9899 пациентов с СД2 в течение более 6 мес до включения в ис-следование получали терапию базальным инсулином. Ис-следование показало, что одна четверть пациентов с СД2, получающих базальный инсулин (23,5% (n=2322)), имеют трудности в достижении рекомендуемой цели HbA 1c , не-смотря на оптимальные показатели гликемии натощак [14]. Большинство пациентов (51,3%) не достигли ни одной из поставленных целей.…”

“…Руководства по терапии СД ре-комендуют раннее назначение сахароснижающей терапии и своевременное назначение комбинации препаратов для улучшения контроля гликемии, но врачи обычно предпо-читают поэтапный подход к лечению больных, вследствие которого пациент зачастую проводит более 10 лет с уров-нем HbA 1c >7% (53 ммоль/моль) и 5 лет с уровнем HbA 1c >8% (64 ммоль/моль), прежде чем доктор назначит инсулин. В этом исследовании восприятие пациентами уровня вов-леченности и внимательности врача, качество объяснения данных лабораторного исследования и интерпретация их результатов, а также обсуждение необходимого режима терапии были непосредственно связаны с поведением па-циентов в отношении соблюдения ими рекомендованного режима инсулинотерапии [14].…”