Insulin Therapy for Type 2 Diabetes Mellitus

Wallia, Amisha; Molitch, Mark E.

doi:10.1001/jama.2014.5951

Cited by 126 publications

(86 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast, the absolute HbA 1c reduction was similar for SU and GLP-1 receptor agonist add-on, although the aRR for reaching HbA 1c <7% (<53 mmol/mol) was slightly higher with GLP-1 receptor agonists. Adjusted estimates for reaching HbA 1c targets with insulin tended to be lower, possibly related to some of the challenges that patients experience with early insulin administration in real life [8]. Nonetheless, our finding of similar HbA 1c levels achieved with insulin and other GLDs despite different HbA 1c baseline levels suggest that physicians choose effective therapy for patients with poor baseline glycaemic control, in accordance with guidelines [4,8].…”

Section: Discussionsupporting

confidence: 57%

Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes

et al. 2015

View full text Add to dashboard Cite

Aims/hypothesis The aims of this work were to assess glycaemic control in metformin users receiving their first add-on glucose-lowering therapy and to examine the real-life effectiveness of different add-on drugs. Methods We carried out a population-based cohort study using healthcare databases in northern Denmark during 2000-2012. We included 4,734 persons who initiated metformin monotherapy and added another glucose-lowering drug within 3 years. Attainment of recommended HbA 1c goals within 6 months of add-on was investigated, using Poisson regression analysis adjusted for age, sex, baseline HbA 1c , diabetes duration, complications and Charlson Comorbidity Index. Results Median metformin treatment duration at intensification was 12 months (interquartile range [IQR] 4-23 months) and pre-intensification HbA 1c was 8.0% (IQR 7.2-9.2%) (64 mmol/mol). Median HbA 1c dropped 1.2% (13 mmol/mol) with a sulfonylurea (SU) add-on, 0.8% (9 mmol/mol) with a dipeptidyl peptidase-4 (DPP-4) inhibitor, 1.3% (14 mmol/mol) with a glucagon-like peptide-1 (GLP-1) receptor agonist, 0.9% (10 mmol/mol) with other non-insulin drugs and 2.4% (26 mmol/mol) with insulin. Compared with SU add-on, attainment of HbA 1c <7% (<53 mmol/mol) was higher with GLP-1 receptor agonists (adjusted RR [aRR] 1.10; 95% CI 1.01, 1.19) and lower with DPP-4 inhibitors (aRR 0.94; 95% CI 0.89, 0.99), other drugs (aRR 0.86; 95% CI 0.77, 0.96) and insulin (aRR 0.88; 95% CI 0.77, 0.99). The proportion of metformin add-on users who attained HbA 1c <7% (<53 mmol/mol) increased from 46% in 2000-2003 to 59% in 2010-2012, whereas attainment of HbA 1c <6.5% (<48 mmol/mol) remained 30% among patients aged <65 years without comorbidities. Conclusions/interpretation Among early type 2 diabetes patients receiving their first metformin add-on treatment, HbA 1c reduction with different non-insulin drugs is similar to, and comparable with, that observed in randomised trials, yet 41% do not achieve HbA 1c <7% (<53 mmol/mol) within 6 months.

show abstract

Section: Discussionsupporting

confidence: 57%

Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes

et al. 2015

View full text Add to dashboard Cite

show abstract

“…There are excellent reviews to guide the initiation and management of insulin therapy to achieve desired glycemic goals (1). Although most studies of multiple-dose insulin versus pump therapy have been small and of short duration, a systematic review and meta-analysis concluded that there are minimal differences between the two forms of intensive insulin therapy in A1C (combined mean between-group difference favoring insulin pump therapy 20.30% [95% CI 20.58 to 20.02]) and severe hypoglycemia rates in children and adults (2).…”

Section: Insulin Therapymentioning

confidence: 99%

7. Approaches to Glycemic Treatment

2015

Diabetes Care

202

117

View full text Add to dashboard Cite

“…1 A single injection of low dosage basal insulin in addition to oral glucose-lowering drugs is mostly used at the beginning, but over time many patients require intensification of insulin therapy (short-acting insulins, premixed insulins) with increasing daily insulin dosages. 1 Observational studies have reported a relationship between insulin use and cardiovascular events in diabetes patients. [2][3][4] This association has been mostly attributed to reverse causality, because the insulin-treated patients were already at an increased risk of cardiovascular events at onset of insulin therapy compared to patients on oral glucoselowering drugs.…”

Section: Original Articlementioning

confidence: 99%

Calculated Daily Insulin Dosages Overestimate Prescribed Insulin Doses in Type 2 Diabetes: A Primary Care Database Study

Kostev

Rathmann

2016

J Diabetes Sci Technol

View full text Add to dashboard Cite

Background:The aim was to compare the prescribed and calculated daily insulin dosages based on prescription data in type 2 diabetes patients in a general practice database. Methods:A total of 17 782 type 2 diabetes patients (age: 70.0 ± 11.5 years; 52% males; 16% diabetologist care) with ≥2 insulin prescriptions from 834 practices were analyzed (Disease Analyser: 01/2011-12/2015. Prescribed daily dosage (PDD) (physician documentation) and calculated daily dose (CDD) (pack size × strength × volume / days between 2 prescriptions) were calculated for short-acting, long-acting, and premixed insulins. PDD and CDD were compared using paired t-tests. Linear regression models assessed the associations of insulin dosage difference (CDD-PDD) with age, sex, diabetologist care, private health insurance, obesity, HbA1c, hypertension, hyperlipidemia, macro-and microvascular complications. Results: Mean [SD] CDDs were higher than PDDs for short-acting (52 [28] vs 48 [26] units/day), long-acting (30 [20] vs 24 [15] units/day), and premixed (46 [26] vs 40 [21] units/day) insulins (all P < .05). In regression models, age (per year) was associated with higher CDD-PDD differences (+0.11, +0.04, +0.10; P < .01) for short-, long-acting, and premixed insulins, respectively. Diabetologist care was related to lower differences (-2.92, -1.02, -3.65; all P < .05). HbA1c was associated with higher differences in long-acting and premixed insulins, but was related to a lower difference in short-acting insulins (all P < .05).Conclusions: CDD in primary care database studies substantially overestimate the PDD (8-25%). Age, diabetologist care, and glycemic control were related to CDD-PDD differences. Priming and safety shots with pens, dosing errors, or the accumulation of insulin reserves by patients may be underlying reasons.

show abstract

Insulin Therapy for Type 2 Diabetes Mellitus

Abstract: Insulin can help achieve ideal hemoglobin A1c goals for patients with type 2 diabetes. Barriers such as adherence, patient preferences, clinician preferences, and resource allocation must be addressed.

Cited by 126 publications

References 94 publications

Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes

Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes

7. Approaches to Glycemic Treatment

Calculated Daily Insulin Dosages Overestimate Prescribed Insulin Doses in Type 2 Diabetes: A Primary Care Database Study

Contact Info

Product

Resources

About