The glycemic efficacies of insulin analogue regimens according to baseline glycemic status in Korean patients with type 2 diabetes: sub‐analysis from the A ₁ chieve ^® study

Abstract

AimsIn this study, we compared the glucose-lowering effectiveness of insulin analogues and their combination according to baseline glycemic status in patients with type 2 diabetes (T2D) from the A1chieve® study conducted in Korea.MethodsThis sub-analysis from the A1chieve® study was a 24-week prospective, multicenter, non-interventional, open-labelled study. Of the 4058 patients, 3074 patients who had their HbA1c level measured at baseline were included in this sub-analysis. We classified patients into three groups according to baseline HbA1c levels: group I (HbA1c < 7.5%), group II (7.5% ≤ HbA1c < 9.0%) and group III (HbA1c ≥ 9.0%).ResultsPatients in group I showed no significant HbA1c reduction with any insulin regimens (detemir, aspart, detemir and aspart or biphasic aspart 30 (Novo Nordisk A/S, DK-2880 Bagsværd, Denmark) after 24 weeks of treatment. In group II, although HbA1c was decreased for all insulin regimens, there was no difference in mean HbA1c reduction among the four insulin regimens. In patients with a high baseline HbA1c level (group III), mean HbA1c reduction was the greatest in patients on a basal-bolus regimen (detemir and aspart, −3.50%) and lowest in patients on a bolus regimen (aspart, −1.81%; p < 0.001).ConclusionFor optimal glycaemic control, a basal-bolus regimen may be adequate for Korean patients with poorly controlled T2D (HbA1c ≥ 9.0%).

Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes

“…The study population and analysis design were described in previous reports [ 3 , 7 ]. Briefly, of the 4058 patients who were administered study insulin at least once in the full analysis set (FAS), 3074 had A1c level measured at baseline and at the final visit; and 2952 (72.7% of the FAS) who received one of the four insulin analog regimens were eligible for analysis.…”

“…The A 1 chieve study in Korea reported a decrease in A1c from 9.4 ± 1.9% at baseline to 8.0 ± 1.4% at 24 weeks in insulin detemir-treated subjects [ 3 ] and no significant A1c reduction with any insulin regimens (BI, bolus regimen and basal–bolus regimen and biphasic regimen) in Korean patients with relatively sub-optimally controlled (A1c <7.5%) T2D [ 7 ]. Another previous observational study, similar result showed that reduction in A1c was 7.6% of final A1c from 8.9% of baseline A1c.…”

“…In addition, the latest sub-analysis from the A 1 chieve study conducted in Korea included 3074 patients who were analyzed in three groups regarding A1c <7.5%/7.5–9%/>9%. No significant A1c reduction was observed with any insulin regimens in Korean patients with relatively well-controlled T2D (A1c <7.5%), a basal–bolus regimen may be adequate for Korean patients with poorly controlled T2D (A1c ≥9.0%) [ 7 ]. Therefore, using data from the A 1 chieve study in Korea, we investigated the effectiveness of the BI analog, insulin detemir (Levemir ® ) in Korean patients with T2D.…”

Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017

“…The progressive nature of T2DM in the deterioration of pancreatic β-cell function was such that after 3 years, approximately 50% of patients could attain glycosylated hemoglobin (HbA1c) below 7% with monotherapy, and by 9 years, this declined to approximately 25% [ 1 ]. Early intensive insulin therapy in patients with newly diagnosed T2DM has favorable outcomes on the recovery and maintenance of β-cell function and protracted glycemic remission compared to treatment with oral hypoglycemic agents (OHAs) [ 3 4 5 6 ]; thus, supporting the rationale for the initiation of insulin therapy in subjects with T2DM whose glycemic targets cannot be achieved with lifestyle modifications and OHAs [ 7 8 ]. The Korean Diabetes Association recommends insulin therapy in two circumstances: timely initial treatment after the diagnosis of T2DM and in cases of OHA failure.…”

Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes

“…To address this, many questions should be clarified in real clinical practice, such as when to initiate insulin (before or after islet failure), which patients to initiate treatment in, which kind of insulin analogue (basal, rapid-acting, biphasic, or combination of basal and rapid-acting insulin analogue) should be used, and how to administer insulin (starting dose, number of injections, divided ratio of total doses, and titration methods) 8910. Previously, we investigated the stage at which both physicians and patients agreed to start insulin therapy, and what are acceptable HbA1c levels for Korean subjects with T2D in real practice 11. We have also tried to answer questions regarding the characteristics of patients who respond adequately to basal plus insulin or to insulin analogues (basal or biphasic insulin analogue) after sulfonylurea failure,1213 as well as the optimal dosing ratio of twice-daily biphasic insulin analogues 1415.…”