Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin

Blak, Betina; Smith, Helen; Hards, Michelle; Curtis, Bradley; Iványi, T.

doi:10.1111/j.1464-5491.2012.03586.x

Cited by 45 publications

(43 citation statements)

References 17 publications

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“…High mean baseline HbA 1c levels were also observed in INSTIGATE 15 and other observational studies 8,[16][17][18][19][20] , indicating a delay in starting insulin therapy that could be caused by resistance to insulin initiation by patients and healthcare providers 21 . In this study as well as in INSTIGATE 9 , the mean HbA 1c level of patients who initiated on long/intermediate insulin regimens was lower than those who initiated on mixtures or basal-bolus regimens, as also recommended in the IDF and ADA-EASD guidelines.…”

Section: Discussionmentioning

confidence: 79%

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Oğuz

Benroubi

Brismar

et al. 2013

Current Medical Research and Opinion

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Section: Discussionmentioning

confidence: 79%

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Oğuz

Benroubi

Brismar

et al. 2013

Current Medical Research and Opinion

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“…Regarding insulin intensification, another primary care database analysis reported that intensification of basal insulin treatment occurred in only 33% of UK patients, despite most having suboptimal glycemic control [6]. This treatment inertia is not confined to the UK: a large observational study (n = 17,374) of ten countries reported that mean HbA 1c at insulin initiation ranged from 67 mmol/mol (8.3%; China) up to 84 mmol/mol (9.8%; UK), with a mean across the study of 74 mmol/mol (8.9%) [7].…”

Section: Clinical Inertiamentioning

confidence: 97%

The place of IDegLira in the management of patients with Type 2 diabetes

Lansdown¹,

Bain²,

Chudleigh³

2015

Diabetes Management

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Type 2 diabetes mellitus is a progressive disease and this means that treatment intensification is needed to achieve glycemic goals and, for many patients, insulin will ultimately be needed. There is the potential for insulin to achieve any glycemic target, however, its initiation and up-titration is frequently delayed, partly due to the attendant weight gain and risk of hypoglycemia. Several clinical trials have demonstrated that combining a GLP-1 receptor agonist with basal insulin produces significant reductions in HbA 1c without substantially increasing hypoglycemia or promoting weight gain. A once-daily coformulation of ultralong-acting basal insulin degludec and the GLP-1 analog liraglutide, termed 'IDegLira', has now been developed for patients with Type 2 diabetes. Data from two Phase III clinical trials are encouraging, demonstrating marked HbA 1c reductions with weight loss, low levels of hypoglycemia and limited gastrointestinal side effects. The types of patients that may benefit from a fixed-ratio combination such as IDegLira are discussed here, as are future developments. BackgroundThe pathophysiology of Type 2 diabetes (T2DM) is characterized by a variable combination of insulin resistance, impaired insulin secretion and hyperglucagonemia. Additional features of the 'ominous octet' of defects in T2DM have also been well described [1]. The progressive nature of T2DM necessitates intensification of treatment to maintain glycemic control over time. Since none of the currently available therapies have been shown to modify the underlying pathophysiology of T2DM, many patients will ultimately need insulin replacement [2].The European Association for the Study of Diabetes (EASD)/American Diabetes Association (ADA) consensus position statement focuses on an HbA 1c of <53 mmol/mol (<7.0%) with initiation of insulin therapy (typically basal insulin) as dual or triple therapy, if a patient does not achieve or maintain target after around 3 months [3]. In England and Wales, when dual oral therapy does not achieve target, NICE recommends intensification with either a third oral agent, a GLP-1 receptor agonist (RA) or basal insulin in patients with an HbA 1c of ≥58 mmol/mol (≥7.5%) [4].

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“…The combination of metformin with long‐acting basal insulin should be considered an essential therapy for patients with advanced disease not achieving agreed HbA1c targets on current antidiabetic medications 13. However, it has been reported that approximately 64% of patients with type 2 diabetes on basal insulin therapy experience inadequate glycaemic control, with 60% not receiving intensified treatment in a timely manner 14, 15. At this stage, intensification to basal‐bolus insulin therapy is typically recommended.…”

Section: Introductionmentioning

confidence: 99%

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

Drummond

Malkin²,

Preez

et al. 2018

Diabetes Obesity Metabolism

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AimTo evaluate the cost‐effectiveness of IDegLira versus basal‐bolus therapy (BBT) with insulin glargine U100 plus up to 4 times daily insulin aspart for the management of type 2 diabetes in the UK.MethodsA Microsoft Excel model was used to evaluate the cost‐utility of IDegLira versus BBT over a 1‐year time horizon. Clinical input data were taken from the treat‐to‐target DUAL VII trial, conducted in patients unable to achieve adequate glycaemic control (HbA1c <7.0%) with basal insulin, with IDegLira associated with lower rates of hypoglycaemia and reduced body mass index (BMI) in comparison with BBT, with similar HbA1c reductions. Costs (expressed in GBP) and event‐related disutilities were taken from published sources. Extensive sensitivity analyses were performed.ResultsIDegLira was associated with an improvement of 0.05 quality‐adjusted life years (QALYs) versus BBT, due to reductions in non‐severe hypoglycaemic episodes and BMI with IDegLira. Costs were higher with IDegLira by GBP 303 per patient, leading to an incremental cost‐effectiveness ratio (ICER) of GBP 5924 per QALY gained for IDegLira versus BBT. ICERs remained below GBP 20 000 per QALY gained across a range of sensitivity analyses.ConclusionsIDegLira is a cost‐effective alternative to BBT with insulin glargine U100 plus insulin aspart, providing equivalent glycaemic control with a simpler treatment regimen for patients with type 2 diabetes inadequately controlled on basal insulin in the UK.

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Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin

Cited by 45 publications

References 17 publications

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

The place of IDegLira in the management of patients with Type 2 diabetes

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

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