The Influence of Insulin Use on Glycemic Control

Abstract

OBJECTIVE -The purposes of this study were to determine the relationship between insulin self-management and glycemic control and to identify patient characteristics associated with better control. RESEARCH DESIGN AND METHODS-A Department of Veterans Affairs regional database was used to identify patients with diabetes on chronic insulin therapy (n ϭ 6,222) with dose defined as number of units and doses. The rate of insulin use during a 2-year period was calculated using pharmacy data. Regression analyses were used 1) to predict compliance with prescribed insulin regimens using demographic variables, HbA 1c levels, and a measure of diabetes management intensity and 2) to predict HbA 1c levels using demographic variables and rates of insulin use.RESULTS -Insulin use was 77.44 Ϯ 17% of prescribed amounts, including wastage; HbA 1c levels were 7.98 Ϯ 1.66%. Concomitant oral hypoglycemic agent use (84.89 Ϯ 16%) was higher than insulin use (P Ͻ 0.0001) but correlated with insulin use (r ϭ 0.189, P Ͻ 0.0001). Ordinary least-squares regression showed that race, HbA 1c levels, and intensity of diabetes management were significant predictors of insulin use. Age, race, and insulin use were significant predictors of HbA 1c levels.CONCLUSIONS -Adults prescribed a specific insulin regimen averaged using 77% of prescribed doses, demonstrating good intention to follow the prescription. However, HbA 1c higher than the recommended level suggested that the rate of insulin use, the prescribed regimen, or both were inadequate to achieve good glycemic control in patients with long-term insulin use. Diabetes Care 28:78 -83, 2005

Effect of Initiation of Basal Insulin Glargine on Glycemic Control in Patients with Diabetes: Real Life Experience from Hong Kong

“…The improvement was achieved without a significant increase in body weight or severe hypoglycaemia. These findings are in agreement with data from other observational studies in which patients were switched to a glargine based regimen [16]- [21]. Our analysis demonstrated a relationship between baseline HbA1c values and the improvement in HbA1c levels.…”

“…Despite the plethora of evidence from various randomised clinical trials confirming the benefits of basal insulin analogue therapy in the management of diabetes, the extent to which these results translates in real life clinical practice is unclear [16] [17]. Several observational studies have attempted to address this issue but those studies were conducted in the Caucasian population [18] [19].…”

Late-night-dinner is associated with poor glycemic control in people with type 2 diabetes: The KAMOGAWA-DM cohort study

“…To investigate the relationship between various factors and hemoglobin A1c, we performed the multiple regression analysis and the following factors, which are including the well-known variates to affect HbA1c [29][30][31], were considered simultaneously as independent variables for multiple regression analysis: sex, BMI, age, duration of diabetes, nighttime sleep duration, time from dinner to bedtime, exercise, smoking, snacking after dinner, alcohol drinking, skipping breakfast, and usage of insulin treatment, insulin secretagogues, insulin sensitizers and nutrient load reducers. We also performed the multiple regression analysis to investigate the relationship between late-night-dinner and Log TG, HDL cholesterol or BMI.…”

Differential Impact of Longitudinal Medication Non-Adherence on Mortality by Race/Ethnicity among Veterans with Diabetes

“…First, MPR is really only a proxy for medication adherence, and because of wastage, the reliability of MPR for insulin needs further validation; however, prior studies of insulin MPR have been conducted using VA data. 22 Second, the VA medical record does not include information on socioeconomic status, which is likely to be an important factor. Third, we were missing information on racial/ethnic group in 8.9 % of the population and cannot rule out that this introduced bias.…”