Trends in Insulin Use and Diabetes Control in the U.S.: 1988–1994 and 1999–2012

Selvin, Elizabeth; Parrinello, Christina M.; Daya, Natalie; Bergenstal, Richard M.

doi:10.2337/dc15-2229

Cited by 98 publications

(81 citation statements)

References 3 publications

(3 reference statements)

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“…In previous reports, only 30% of patients with diabetes in the United States on insulin therapy achieved an HbA1c of £7.0% (£53 mmol/mol). 4,5 Moreover, in our study, there was a statistically significant, although marginal, reduction in glycemic variability (assessed by measuring the CV of SMBG measurements on multiple, 7-point SMBG profiles over 3 days) with the patch versus pen after 44 weeks. The reduction in glycemic variability was not apparent at week 24.…”

Section: Discussionmentioning

confidence: 48%

“…1,2 Despite an increasing number of treatment options, only about 50% of people with diabetes on any therapy and <30% of people with diabetes using some form of insulin therapy achieve the recommended treatment goal of glycated hemoglobin (HbA1c) <7.0% (<53 mmol/mol). [3][4][5] Current guidelines recommend a stepwise approach to treatment intensification, with a combination of oral and/or injectable antihyperglycemic agents for people with type 2 diabetes who do not achieve glycemic goals with lifestyle management and pharmacologic monotherapy (typically metformin).…”

Section: Introductionmentioning

confidence: 99%

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Implementation of Basal–Bolus Therapy in Type 2 Diabetes: A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Bergenstal

Peyrot

Dreon

et al. 2019

Diabetes Technology & Therapeutics

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Background: Barriers to mealtime insulin include complexity, fear of injections, and lifestyle interference. This multicenter, randomized controlled trial evaluated efficacy, safety, and self-reported outcomes in adults with type 2 diabetes, inadequately controlled on basal insulin, initiating and managing mealtime insulin with a wearable patch versus an insulin pen. Methods: Adults with type 2 diabetes ( n = 278, age: 59.2 ± 8.9 years), were randomized to patch ( n = 139) versus pen ( n = 139) for 48 weeks, with crossover at week 44. Baseline insulin was divided 1:1 basal: bolus. Using a pattern-control logbook, subjects adjusted basal and bolus insulin weekly using fasting and premeal glucose targets. Results: Glycated hemoglobin (HbA1c) change (least squares mean ± standard error) from baseline to week 24 (primary endpoint) improved ( P < 0.0001) in both arms, −1.7% ± 0.1% and −1.6% ± 0.1% for patch and pen (−18.6 ± 1.1 and −17.5 ± 1.1 mmol/mol), and was maintained at 44 weeks. The coefficient of variation of 7-point self-monitoring blood glucose decreased more ( P = 0.02) from baseline to week 44 for patch versus pen. There were no differences in adverse events, including hypoglycemia (three severe episodes per arm), and changes in weight and insulin doses. Subject-reported treatment satisfaction, quality of life, experience ratings at week 24, and device preferences at week 48 significantly favored the patch. Most health care providers preferred patch for mealtime insulin. Conclusions: Bolus insulin delivered by patch and pen using an algorithm-based weekly insulin dose titration significantly improved HbA1c in adults with type 2 diabetes, with improved subject and health care provider experience and preference for the patch.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Implementation of Basal–Bolus Therapy in Type 2 Diabetes: A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Bergenstal

Peyrot

Dreon

et al. 2019

Diabetes Technology & Therapeutics

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“…At this point, only exogenous insulin therapy can alleviate their hyperglycaemia. By that time, many have developed complications . People with type 2 diabetes who use insulin represent approximately one‐quarter of the patient population .…”

Section: Index Casementioning

confidence: 99%

“…People with type 2 diabetes who use insulin represent approximately one‐quarter of the patient population . All over the Western world, most patients do not achieve recommended target HbA1c values, and a third have HbA1c values >75 mmol/mol (9%) …”

Section: Index Casementioning

confidence: 99%

Insulin therapy, weight gain and prognosis

Hodish

2018

Diabetes Obesity Metabolism

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Insulin therapy is mainly used by people with type 2 diabetes who have failed other therapies and have become insulin-deficient. This group represents about a quarter of all people with type 2 diabetes. Almost all those with type 2 diabetes who start insulin therapy or intensify it gain weight, which may potentially diminish the prognostic advantage of improved glycaemia. To date, all available guidelines emphasize both the attainment of glycated haemoglobin (HbA1c) goals and weight control, without directing the clinician as to which element is of a higher priority. The following review attempts to clarify the issue using the available literature. The body of evidence presented in this review indicates that glycaemic management with exogenous insulin replacement is of a much higher priority than weight gain. Lower weight or weight loss do not show prognostic benefit in advanced stages of diabetes; therefore, weight gain should not discourage providers from achieving and maintaining HbA1c goals with insulin therapy, regardless of insulin dosage or other medications.

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“…Poor glycemic control on insulin therapy may be related to several factors, including inappropriate dosing of insulin, poor adherence to insulin therapy or blood glucose monitoring, low socioeconomic status issues, or other unclear factors. HbA 1c outcomes in youth with T2D are much poorer than those in adults with T2D, since approximately 30% of adults with T2D on insulin therapy are able to lower HbA 1c to <7% and 60% achieve an HbA 1c <8% [17]. These observations underscore the need to better understand the barriers to efficacious insulin therapy, including barriers to medication adherence to insulin therapy, in the management of T2D in youth.…”

Section: Discussionmentioning

confidence: 99%

Initial Presentation of Type 2 Diabetes in Adolescents Predicts Durability of Successful Treatment with Metformin Monotherapy: Insights from the Pediatric Diabetes Consortium T2D Registry

et al. 2017

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Background/Aims: Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis. Methods: Enrollment data from the Pediatric Diabetes Consortium T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA_1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared. Results: At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA_1c (9.9% [85 mmol/mol] vs. 5.9% [41 mmol/mol], p < 0.001). Lower HbA_1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA_1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA_1c trajectory after diagnosis was worse in group 2. Conclusion: Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA_1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA_1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.

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Trends in Insulin Use and Diabetes Control in the U.S.: 1988–1994 and 1999–2012

Cited by 98 publications

References 3 publications

Implementation of Basal–Bolus Therapy in Type 2 Diabetes: A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Implementation of Basal–Bolus Therapy in Type 2 Diabetes: A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Insulin therapy, weight gain and prognosis

Initial Presentation of Type 2 Diabetes in Adolescents Predicts Durability of Successful Treatment with Metformin Monotherapy: Insights from the Pediatric Diabetes Consortium T2D Registry

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