Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

Abstract

AimsTo evaluate short‐ and long‐term glycaemic control and hypoglycaemia incidence in insulin‐naïve patients ≥30 years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti‐hyperglycaemic drugs (OADs).MethodsThis was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short‐term (0‐3 months post BI initiation) factors associated with long‐term (3‐24 months) glycaemic control and hypoglycaemia.ResultsOverall, 40 627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24 months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3 months was associated with increased risk of failing to achieve target at 24 months (odds ratio [OR], 3.70 [95% CI, 3.41‐4.00]). Over 24 months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3‐month period was associated with longer‐term risk of these events over the ensuing 3 to 24 months (OR, 5.71 [95% CI, 4.67‐6.99]).ConclusionsInitiating BI with or without OADs is associated with short‐ and long‐term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3 months, or after 2 years of BI treatment. Treatment response and hypoglycaemia incidence by 3 months post BI initiation are associated with longer‐term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti‐hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

The Diabetes Unmet Need with Basal Insulin Evaluation (DUNE) study in type 2 diabetes: Achieving HbA1c targets with basal insulin in a real‐world setting

“…26 Furthermore, hypoglycaemia data were collected by physicians only at week 12, based on patient diaries, which may be subject to recall bias. However, a recent real-world clinical study reported that decline in HbA1c occurs, for the most part, during the first 3 months of insulin titration, with limited further decline thereafter, 10 suggesting that the HbA1c levels reached during the DUNE study would reflect longer-term levels. The 3-month study period may have been insufficient to allow participants with higher baseline HbA1c levels to reach glycaemic targets.…”

“…[8][9][10][11] For example, in two international real-world studies, only 27% to 33% of individuals with T2DM achieved HbA1c less than 7.0% (<53 mmol/mol) after initiating BI therapy. [8][9][10][11] For example, in two international real-world studies, only 27% to 33% of individuals with T2DM achieved HbA1c less than 7.0% (<53 mmol/mol) after initiating BI therapy.…”

“…[8][9][10][11] For example, in two international real-world studies, only 27% to 33% of individuals with T2DM achieved HbA1c less than 7.0% (<53 mmol/mol) after initiating BI therapy. 10 Recent international treatment guidelines advocate setting individualized HbA1c targets that take account of the individual's characteristics, duration of diabetes, co-morbidities, life expectancy and risk of hypoglycaemia. 10 Recent international treatment guidelines advocate setting individualized HbA1c targets that take account of the individual's characteristics, duration of diabetes, co-morbidities, life expectancy and risk of hypoglycaemia.…”

The efficacy of propolis on markers of glycemic control in adults with type 2 diabetes mellitus: A systematic review and meta‐analysis

“…Experts have reported that prediabetes can precede T2DM by 10 to 20 years (Tabák, Herder, Rathmann, Brunner, & Kivimäki, ). If prediabetes and consequently T2DM are not well controlled, well‐established research has shown that they can lead to serious complications such as heart and renal failure, visual impairment, and vascular disorders, which can eventually impose enormous direct and indirect costs to global health‐care systems (Fonseca, Chou, Chung, & Gerrits, ; A. Hadi, Pourmasoumi, Mohammadi, Symonds, & Miraghajani, ; Mauricio et al, ; Stratton et al, ). Thus, appropriate T2DM management is a public health imperative.…”

Basal insulin therapy: Unmet medical needs in Asia and the new insulin glargine in diabetes treatment

“…Although comprehensive guidelines for the treatment of type 2 diabetes patients emphasized the importance of glycemic control with appropriate antihyperglycemic medications and lifestyle modifications, inadequate glycemic control still occurs in many patients because of the delayed insulin initiation or intensification. A retrospective longitudinal analysis of 40,627 type 2 diabetes patients from five European countries and the USA showed poor glycemic control in patients initiating basal insulin. It was found that the proportion of patients for short‐term and long‐term optimal glycemic control increased after the initiation of basal insulins with or without OADs.…”