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Diabetes Obes Metab. 2019 Feb;21(2):321-329. doi: 10.1111/dom.13607.

Commencing insulin glargine 100 U/mL therapy in individuals with type 2 diabetes: Determinants of achievement of HbA1c goal less than 7.0.

Author information

1
Swansea University, Diabetes Research Group Cymru, College of Medicine, Swansea, UK.
2
Sanofi, Frankfurt, Germany.
3
The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
4
Sanofi US, Bridgewater, New Jersey.
5
Department of Medical School, Institute of Cellular Medicine, Diabetes, Newcastle University, Newcastle upon Tyne, UK.
6
Department of Internal Medicine, Endocrinology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas.
7
Department of Internal Medicine, University of Perugia School of Medicine, Perugia, Italy.

Abstract

AIMS:

To identify factors associated with achievement of glycated haemoglobin A1c (HbA1c) target at 24 weeks after commencing basal insulin therapy in individuals with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS:

Post-hoc pooled analysis of 16 randomized, treat-to-target trials involving individuals with T2DM inadequately controlled with oral anti-hyperglycaemic drugs (n = 3415) initiated on once-daily insulin glargine 100 U/mL (Gla-100). Clinical outcomes were assessed by HbA1c response at 24 weeks and individuals were classified as "good responders" with HbA1c <7.0% (<53 mmol/mol) or as "poor responders" with HbA1c ≥7.0% (≥53 mmol/mol). Univariable and multivariable stepwise logistic regression analyses were performed to identify predictive factors for attaining HbA1c <7.0%.

RESULTS:

Lower levels of baseline HbA1c, fasting plasma glucose (FPG) and post-prandial plasma glucose (PPG), higher body mass index (BMI), shorter diabetes duration and male sex were associated with a good glycaemic response, but not age or baseline C-peptide levels. Gla-100 dose (U/kg) was highest in the poor-responder group, which had the fewest hypoglycaemia episodes. Univariable analysis for achievement of HbA1c <7.0% confirmed these observations. Multivariable analysis retained baseline HbA1c, body weight, BMI, sex, 2-hours PPG and diabetes duration as predictors of a good response. Continued use of sulfonylureas, hypoglycaemia and change in body weight were indicative of poor response.

CONCLUSIONS:

Baseline HbA1c was the strongest determinant for achieving target HbA1c <7.0% by supplementary Gla-100 therapy, while sex and BMI were also useful indicators. However, age and C-peptide levels at baseline did not predict glycaemic response to the introduction of basal insulin.

KEYWORDS:

basal insulin; glycaemic control; hypoglycaemia; meta-analysis; type 2 diabetes

PMID:
30520217
DOI:
10.1111/dom.13607

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