Glycosylated hemoglobin level and number of oral antidiabetic drugs predict whether or not glycemic target is achieved in insulin-requiring type 2 diabetes

Lin, Shi-Dou; Tsai, Shih-Tzer; Tu, Shih‐Te; Su, Ching-Chieh; Chen, Jung‐Fu; Lu, Chieh-Hsiang; Wang, Chao-Hung; Yu, Neng-Chun; Hsu, Shang-Ren; Hsieh, Ming‐Chia

doi:10.1016/j.pcd.2014.05.005

Cited by 13 publications

(18 citation statements)

References 36 publications

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“…While findings of the present analysis are consistent with those of other RCTs, pharmaco‐epidemiological and prospective cohort studies involving basal insulin and other insulin types, the analysis reflects only a subpopulation of those starting insulin in the real world …”

Section: Discussionsupporting

confidence: 88%

“…Therefore, a better understanding of the relationship between baseline characteristics and glycaemic outcomes may help to prevent unnecessary delay in optimizing the use of basal insulin therapy. Previous studies have investigated the relevance of baseline characteristics to determine effective outcomes in individuals with T2DM who are initiating insulin therapy . Those characteristics that have been shown to be associated with an inadequate glycaemic response, that is, not achieving HbA1c less than 7.0% (<53 mmol/mol), include the number of oral anti‐hyperglycaemic drugs (OADs) prescribed at baseline, in addition to HbA1c, fasting plasma glucose (FPG) levels, body mass index (BMI), diabetes duration and sex …”

Section: Introductionmentioning

confidence: 99%

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Commencing insulin glargine 100 U/mL therapy in individuals with type 2 diabetes: Determinants of achievement of HbA1c goal less than 7.0%

Owens

Landgraf

Frier

et al. 2019

Diabetes Obesity Metabolism

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Aims To identify factors associated with achievement of glycated haemoglobin A1c (HbA1c) target at 24 weeks after commencing basal insulin therapy in individuals with type 2 diabetes mellitus (T2DM). Materials and methods Post‐hoc pooled analysis of 16 randomized, treat‐to‐target trials involving individuals with T2DM inadequately controlled with oral anti‐hyperglycaemic drugs (n = 3415) initiated on once‐daily insulin glargine 100 U/mL (Gla‐100). Clinical outcomes were assessed by HbA1c response at 24 weeks and individuals were classified as “good responders” with HbA1c <7.0% (<53 mmol/mol) or as “poor responders” with HbA1c ≥7.0% (≥53 mmol/mol). Univariable and multivariable stepwise logistic regression analyses were performed to identify predictive factors for attaining HbA1c <7.0%. Results Lower levels of baseline HbA1c, fasting plasma glucose (FPG) and post‐prandial plasma glucose (PPG), higher body mass index (BMI), shorter diabetes duration and male sex were associated with a good glycaemic response, but not age or baseline C‐peptide levels. Gla‐100 dose (U/kg) was highest in the poor‐responder group, which had the fewest hypoglycaemia episodes. Univariable analysis for achievement of HbA1c <7.0% confirmed these observations. Multivariable analysis retained baseline HbA1c, body weight, BMI, sex, 2‐hours PPG and diabetes duration as predictors of a good response. Continued use of sulfonylureas, hypoglycaemia and change in body weight were indicative of poor response. Conclusions Baseline HbA1c was the strongest determinant for achieving target HbA1c <7.0% by supplementary Gla‐100 therapy, while sex and BMI were also useful indicators. However, age and C‐peptide levels at baseline did not predict glycaemic response to the introduction of basal insulin.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Commencing insulin glargine 100 U/mL therapy in individuals with type 2 diabetes: Determinants of achievement of HbA1c goal less than 7.0%

Owens

Landgraf

Frier

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…The variable referring to the therapeutic regimen was independently associated with glycemic control, so that people with DM using insulin with or without associated OAD presented a significantly higher probability of having an inadequate glycemic control remaining in the final regression model, and thus corroborating the results found in several studies in the literature (8,10,12,19,(29)(30) . This result was already expected, since insulin is the last resort for DM treatment (4,8) .…”

Section: Descriptoressupporting

confidence: 82%

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Lima

Fontbonne

Carvalho

et al. 2016

Rev. esc. enferm. USP

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Objective: Identifying factors associated with glycemic control in people with type 2 Diabetes Mellitus (DM) registered in the Family Health Strategy (FHS) in Pernambuco, Brazil. Method: Associations between glycemic control (glycosylated hemoglobin A lower or equal to 7%) presented by people with DM and variables related to sociodemographic conditions, lifestyle, characteristics of diabetes, treatment and follow-up of patients by health services were investigated by multiple regression. Results: More than 65% of the participants presented inadequate glycemic control, especially those with lower age, longer illness duration, more annual contacts with FHS and complex therapeutic regimen. People with DM without referrals to specialists presented greater glycemic control. Associations with education level and obesity did not remain significant in the multivariate model. Conclusion: The evolution of diabetes hinders adequate control, however, attention to younger people with DM and referrals to specialists are factors that can improve glycemic control. DESCRIPTORS

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“…Early insulin initiation is suggested to preserve β‐cell function, but in real‐world clinical practice insulin is still commonly prescribed at a later stage of an antidiabetic treatment course because of clinical inertia . Most patients with type 2 diabetes mellitus (T2DM) generally do not begin insulin therapy until they have experienced poor glycaemic control using three oral antidiabetic drugs (OADs) . Insulin initiation is often delayed or patients have poor adherence to insulin therapy because of their fears about difficulty with injections, weight gain and hypoglycaemia .…”

Section: Introductionmentioning

confidence: 99%

Effects on clinical outcomes of intensifying triple oral antidiabetic drug (OAD) therapy by initiating insulin versus enhancing OAD therapy in patients with type 2 diabetes: A nationwide population‐based, propensity‐score‐matched cohort study

Kuo

Yang

et al. 2018

Diabetes Obesity Metabolism

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Glycosylated hemoglobin level and number of oral antidiabetic drugs predict whether or not glycemic target is achieved in insulin-requiring type 2 diabetes

Cited by 13 publications

References 36 publications

Commencing insulin glargine 100 U/mL therapy in individuals with type 2 diabetes: Determinants of achievement of HbA1c goal less than 7.0%

Commencing insulin glargine 100 U/mL therapy in individuals with type 2 diabetes: Determinants of achievement of HbA1c goal less than 7.0%

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Effects on clinical outcomes of intensifying triple oral antidiabetic drug (OAD) therapy by initiating insulin versus enhancing OAD therapy in patients with type 2 diabetes: A nationwide population‐based, propensity‐score‐matched cohort study

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