Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis

Karel Kostev,1 Franz W Dippel,2 Wolfgang Rathmann3 1IMS Health, Frankfurt, 2Sanofi-Aventis Deutschland GmbH, Berlin, 3Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany Background: When target glycated hemoglobin (HbA1C) levels are not reached, basal insu...

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Autores principales:	Kostev K, Dippel FW, Rathmann W
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/d96a65697f744995b869d645dbf1f710
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spelling	oai:doaj.org-article:d96a65697f744995b869d645dbf1f7102021-12-02T02:49:53ZGlycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis1178-7007https://doaj.org/article/d96a65697f744995b869d645dbf1f7102015-01-01T00:00:00Zhttp://www.dovepress.com/glycemic-control-after-initiating-basal-insulin-therapy-in-patients-wi-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007 Karel Kostev,1 Franz W Dippel,2 Wolfgang Rathmann3 1IMS Health, Frankfurt, 2Sanofi-Aventis Deutschland GmbH, Berlin, 3Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany Background: When target glycated hemoglobin (HbA1C) levels are not reached, basal insulin therapy should be considered in type 2 diabetes. The objective of this report was to describe the predictors of glycemic control (strict criterion: HbA1c ≤6.5%) during the first year after initiating basal insulin therapy in primary care.Methods: The study applied a retrospective approach using a nationwide database in Germany (Disease Analyzer, IMS Health, January 2008 to December 2011, including 1,024 general and internal medicine practices). Potential predictors of glycemic control considered were age, sex, duration of diabetes, type of basal insulin, comedication with short-acting insulin, baseline HbA1c, previous oral antidiabetic drugs, diabetologist care, private health insurance, macrovascular and microvascular comorbidity, and concomitant medication. Multivariable logistic regression models were fitted with glycemic control as the dependent variable.Results: A total of 4,062 type 2 diabetes patients started basal insulin (mean age 66 years, males 53%, diabetes duration 4.8 years, mean HbA1c 8.8%), of whom 295 (7.2%) achieved an HbA1c ≤6.5% during the one-year follow-up. Factors positively associated with HbA1c ≤6.5% in logistic regression were male sex (odds ratio 1.59, 95% confidence interval 1.23–2.04), insulin glargine (reference neutral protamine Hagedorn; odds ratio 1.43, 95% confidence interval 1.09–1.88), short-acting insulin (odds ratio 1.33, 95% confidence interval 1.01–1.76), and prior treatment with metformin, dipeptidyl peptidase-4 inhibitors, and diuretics. Lipid-lowering drugs were associated with a lower odds of reaching the glycemic target.Conclusion: Few type 2 diabetes patients (7%) reached the glycemic target (HbA1c ≤6.5%) after one year of basal insulin therapy. Achievement of the glycemic target was associated with type of basal insulin, additional short-acting insulins, previous antidiabetic medication, and other comedication, eg, diuretics or lipid-lowering drugs.Keywords: insulin initiation, type 2 diabetes, glycemic control, basal insulin, primary careKostev KDippel FWRathmann WDove Medical PressarticleSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol 2015, Iss default, Pp 45-48 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Specialties of internal medicine RC581-951
spellingShingle	Specialties of internal medicine RC581-951 Kostev K Dippel FW Rathmann W Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
description	Karel Kostev,1 Franz W Dippel,2 Wolfgang Rathmann3 1IMS Health, Frankfurt, 2Sanofi-Aventis Deutschland GmbH, Berlin, 3Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany Background: When target glycated hemoglobin (HbA1C) levels are not reached, basal insulin therapy should be considered in type 2 diabetes. The objective of this report was to describe the predictors of glycemic control (strict criterion: HbA1c ≤6.5%) during the first year after initiating basal insulin therapy in primary care.Methods: The study applied a retrospective approach using a nationwide database in Germany (Disease Analyzer, IMS Health, January 2008 to December 2011, including 1,024 general and internal medicine practices). Potential predictors of glycemic control considered were age, sex, duration of diabetes, type of basal insulin, comedication with short-acting insulin, baseline HbA1c, previous oral antidiabetic drugs, diabetologist care, private health insurance, macrovascular and microvascular comorbidity, and concomitant medication. Multivariable logistic regression models were fitted with glycemic control as the dependent variable.Results: A total of 4,062 type 2 diabetes patients started basal insulin (mean age 66 years, males 53%, diabetes duration 4.8 years, mean HbA1c 8.8%), of whom 295 (7.2%) achieved an HbA1c ≤6.5% during the one-year follow-up. Factors positively associated with HbA1c ≤6.5% in logistic regression were male sex (odds ratio 1.59, 95% confidence interval 1.23–2.04), insulin glargine (reference neutral protamine Hagedorn; odds ratio 1.43, 95% confidence interval 1.09–1.88), short-acting insulin (odds ratio 1.33, 95% confidence interval 1.01–1.76), and prior treatment with metformin, dipeptidyl peptidase-4 inhibitors, and diuretics. Lipid-lowering drugs were associated with a lower odds of reaching the glycemic target.Conclusion: Few type 2 diabetes patients (7%) reached the glycemic target (HbA1c ≤6.5%) after one year of basal insulin therapy. Achievement of the glycemic target was associated with type of basal insulin, additional short-acting insulins, previous antidiabetic medication, and other comedication, eg, diuretics or lipid-lowering drugs.Keywords: insulin initiation, type 2 diabetes, glycemic control, basal insulin, primary care
format	article
author	Kostev K Dippel FW Rathmann W
author_facet	Kostev K Dippel FW Rathmann W
author_sort	Kostev K
title	Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
title_short	Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
title_full	Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
title_fullStr	Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
title_full_unstemmed	Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
title_sort	glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/d96a65697f744995b869d645dbf1f710
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Glycemic control after initiating basal insulin therapy in patients with type 2 diabetes: a primary care database analysis

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