Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin.
Summary of "Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin."
Aims:â€‚ To describe patients with Type 2 diabetes mellitus treated with basal insulin, with or without oral antidiabetics in UK primary care, and evaluate insulin treatment patterns and factors explaining changes in therapy. Methods:â€‚ Retrospective analysis of patients with Type 2 diabetes within The Health Improvement Network UK primary care database. Patients receiving basal insulin between January and June 2006 were followed until July 2009. Results:â€‚ Analysis included 3185 patients, mean age 65.6â€ƒyears [standard deviation (SD) 12.4], 50.9% men, median diabetes duration 9.6â€ƒyears, median basal insulin use 1.3â€ƒyears, 86.5% had received oral antidiabetics in the previous 12â€ƒmonths. Mean follow-up was 2.9â€ƒyears (SD 1.0), 59.8% patients maintained basal insulin throughout follow-up with a mean HbA(1C) of 69â€ƒmmol/mol (SD 19 8.4%, SD 1.7) at baseline and 65â€ƒmmol/mol (SD 17; 8.1%, SD 1.6) during follow-up. During follow-up, 6.9% of patients discontinued, 19.3% intensified with and 14.1% switched to prandial or premixed insulin. Patients who intensified (prandial) had a mean HbA(1c) of 77â€ƒmmol/mol (SD 18; 9.2%, SD 1.6) before change and a mean HbA(1c) of 71â€ƒmmol/mol (SD 21; 8.6%, SD 2.0) at the end of the study. Those switching to premixed insulin had mean a HbA(1c) of 80â€ƒmmol/mol (SD 18; 9.5%, SD 1.7) before change and a HbA(1c) of 69â€ƒmmol/mol (SD 17; 8.5%, SD 1.5) at the end of the study. Increasing HbA(1c) and longer diabetes duration explained intensification and switch. Conclusions:â€‚ The majority of patients had HbA(1c) above the 53â€ƒmmol/mol (<â€ƒ7%) target at baseline and post-intensification/switch. The HbA(1c) levels were reduced by intensification/switch suggesting that insulin changes did have some impact. Most patients did not change insulin treatment despite having higher than recommended HbA(1c) levels. Reasons for not changing treatment in face of unsatisfactory clinical outcomes are unclear. Further research is warranted to explore barriers towards therapy change. Â© 2012 The Authors. Diabetic Medicine Â© 2012 Diabetes UK.
Cegedim Strategic Data Medical Research Ltd, London Lilly UK, Erl Wood Manor, Windlesham, UK Lilly USA, Indianapolis, IN, USA Lilly Hungary, Budapest, Hungary.
This article was published in the following journal.
Name: Diabetic medicine : a journal of the British Diabetic Association
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22268988
- DOI: http://dx.doi.org/10.1111/j.1464-5491.2012.03586.x
Insulin degludec is a new, ultra-long-acting basal insulin. The aim of this study was to analyze the changes of basal insulin dose and blood glucose profile in basal-bolus therapy of type 1 diabetes m...
The probability and risk of operations increase in patients with type 2 diabetes mellitus. For diabetic patients, blood glucose control is a key factor to improving the prognosis of surgery. During pe...
Diabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus. It is a clinically relevant condition with a prevalence of 5%-10% among all d...
Many patients with typeÂ 2 diabetes mellitus (T2DM) on insulin therapy have inadequate glycaemic control. In such cases, Dutch guidelines recommend unlimited up-titration of insulin, yet in practice m...
Type 2 diabetes mellitus patients with coronary artery disease have become a major public health concern. The occurrence of insulin resistance accompanied with endothelial dysfunction worsens the stat...
This is a study with two treatment sequences and two treatment periods that will assess the safety and efficacy of exenatide treatment in patients with type 2 diabetes who have inadequate...
A study to test for non-inferiority of preprandial HIIP [also known as AIRÂ® Inhaled Insulin Powder][AIRÂ® is a registered trademark of Alkermes,Inc.] compared with preprandial injectable...
The purpose of this study is to see whether IN-105 (oral insulin) is able to control increase in blood glucose after eating a meal. This study will also tell whether single tablet of IN-10...
This trial was designed to compare meal related inhalation of Technosphere/Insulin to subcutaneous regular insulin in patients with type 2 diabetes.
The purpose of this study is to compare whether there is the difference in the effect of insulin therapy by the number of times of insulin injection.
Medical and Biotech [MESH] Definitions
A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.
A subtype of DIABETES MELLITUS that is characterized by INSULIN deficiency. It is manifested by the sudden onset of severe HYPERGLYCEMIA, rapid progression to DIABETIC KETOACIDOSIS, and DEATH unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence.
A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
The time period before the development of symptomatic diabetes. For example, certain risk factors can be observed in subjects who subsequently develop INSULIN RESISTANCE as in type 2 diabetes (DIABETES MELLITUS, TYPE 2).
A strain of Rattus norvegicus which is a model for spontaneous insulin-dependent diabetes mellitus (DIABETES MELLITUS, INSULIN-DEPENDENT).