Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

Dídac Mauricio, Luigi Meneghini, Jochen Seufert, Laura Liao, Hongwei Wang, Liyue Tong, Anna Cali, Peter Stella, Paulo Carita, Kamlesh Khunti

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Aims: To evaluate short- and long-term glycaemic control and hypoglycaemia incidence in insulin-naïve patients ≥30years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti-hyperglycaemic drugs (OADs). Methods: This was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short-term (0-3months post BI initiation) factors associated with long-term (3-24months) glycaemic control and hypoglycaemia. Results: Overall, 40627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3months was associated with increased risk of failing to achieve target at 24months (odds ratio [OR], 3.70 [95% CI, 3.41-4.00]). Over 24months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3-month period was associated with longer-term risk of these events over the ensuing 3 to 24months (OR, 5.71 [95% CI, 4.67-6.99]). Conclusions: Initiating BI with or without OADs is associated with short- and long-term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3months, or after 2years of BI treatment. Treatment response and hypoglycaemia incidence by 3months post BI initiation are associated with longer-term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti-hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

Original languageEnglish (US)
JournalDiabetes, Obesity and Metabolism
DOIs
StateAccepted/In press - 2017

Fingerprint

Hypoglycemia
Type 2 Diabetes Mellitus
Insulin
Hypoglycemic Agents
Logistic Models
Odds Ratio
Peptide Initiation Factors
Electronic Health Records
Incidence
Pharmaceutical Preparations
Blood Glucose
Therapeutics

Keywords

  • Basal insulin
  • Glycaemic control
  • Hypoglycaemia
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA. / Mauricio, Dídac; Meneghini, Luigi; Seufert, Jochen; Liao, Laura; Wang, Hongwei; Tong, Liyue; Cali, Anna; Stella, Peter; Carita, Paulo; Khunti, Kamlesh.

In: Diabetes, Obesity and Metabolism, 2017.

Research output: Contribution to journalArticle

Mauricio, Dídac ; Meneghini, Luigi ; Seufert, Jochen ; Liao, Laura ; Wang, Hongwei ; Tong, Liyue ; Cali, Anna ; Stella, Peter ; Carita, Paulo ; Khunti, Kamlesh. / Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA. In: Diabetes, Obesity and Metabolism. 2017.
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T1 - Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

AU - Mauricio, Dídac

AU - Meneghini, Luigi

AU - Seufert, Jochen

AU - Liao, Laura

AU - Wang, Hongwei

AU - Tong, Liyue

AU - Cali, Anna

AU - Stella, Peter

AU - Carita, Paulo

AU - Khunti, Kamlesh

PY - 2017

Y1 - 2017

N2 - Aims: To evaluate short- and long-term glycaemic control and hypoglycaemia incidence in insulin-naïve patients ≥30years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti-hyperglycaemic drugs (OADs). Methods: This was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short-term (0-3months post BI initiation) factors associated with long-term (3-24months) glycaemic control and hypoglycaemia. Results: Overall, 40627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3months was associated with increased risk of failing to achieve target at 24months (odds ratio [OR], 3.70 [95% CI, 3.41-4.00]). Over 24months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3-month period was associated with longer-term risk of these events over the ensuing 3 to 24months (OR, 5.71 [95% CI, 4.67-6.99]). Conclusions: Initiating BI with or without OADs is associated with short- and long-term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3months, or after 2years of BI treatment. Treatment response and hypoglycaemia incidence by 3months post BI initiation are associated with longer-term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti-hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

AB - Aims: To evaluate short- and long-term glycaemic control and hypoglycaemia incidence in insulin-naïve patients ≥30years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti-hyperglycaemic drugs (OADs). Methods: This was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short-term (0-3months post BI initiation) factors associated with long-term (3-24months) glycaemic control and hypoglycaemia. Results: Overall, 40627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3months was associated with increased risk of failing to achieve target at 24months (odds ratio [OR], 3.70 [95% CI, 3.41-4.00]). Over 24months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3-month period was associated with longer-term risk of these events over the ensuing 3 to 24months (OR, 5.71 [95% CI, 4.67-6.99]). Conclusions: Initiating BI with or without OADs is associated with short- and long-term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3months, or after 2years of BI treatment. Treatment response and hypoglycaemia incidence by 3months post BI initiation are associated with longer-term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti-hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

KW - Basal insulin

KW - Glycaemic control

KW - Hypoglycaemia

KW - Type 2 diabetes

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U2 - 10.1111/dom.12927

DO - 10.1111/dom.12927

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JF - Diabetes, Obesity and Metabolism

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