Effectiveness of premixed insulin to achieve glycaemic control in type 2 diabetes: A retrospective UK cohort study

Edward B. Jude, Carlos Trescoli, Rifat Emral, Amar Ali, Robert Lubwama, Karen Palmer, Alka Shaunik, Nithya Nanda, Philip Raskin, Fernando Gomez-Peralta

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Aim: To investigate the effectiveness of premixed insulin for achieving glycaemic outcomes in clinical practice in the UK. Materials and Methods: Electronic medical record data from The Health Improvement Network database were captured for adults with type 2 diabetes (T2D) uncontrolled (HbA1c ≥9%) on two or more oral antihyperglycaemic drugs (OADs) initiating premixed insulin. Effectiveness of premixed insulin was assessed by the probability and incidence of achieving glycaemic outcomes (target HbA1c <7.5% [<58 mmol/mol] and a ≥1% or ≥2% HbA1c reduction) over 24 months. Results: Data from 974 participants (mean age 62 years; 56% male; 52% obese or extremely obese; mean HbA1c 11.3% [100 mmol/mol]; hypertension 64%, dyslipidaemia 23% and nephropathy 21%) were analysed. The probability of achieving HbA1c <7.5% was highest during months 3-6 (18.2%), while the cumulative probability of achieving this target plateaued between months 15-24 (15.7%-16.0%). Incidence of achieving all glycaemic outcomes plateaued after 12 months and differed by baseline HbA1c, but not OAD use. Factors affecting some glycaemic outcomes included a body mass index >40 kg/m2 and co-morbidities including nephropathy and stroke. Conclusions: In people with uncontrolled T2D (HbA1c ≥9%), glycaemic outcome achievement on premixed insulin was low at 6 months with little additional clinical benefit beyond 12 months, suggesting a high unmet need for early, timely treatment changes with more effective, simpler therapies.

Original languageEnglish (US)
Pages (from-to)929-937
Number of pages9
JournalDiabetes, Obesity and Metabolism
Volume23
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • database research, glycaemic control, insulin therapy, type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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