Predictors of Glycemic Response and Change in HbA1c Following Newly Initiated Basal Insulin Among Insulin Naïve Adults With Type 2 Diabetes
Abstract
This sub-analysis of the Iran-AFECT study was to determine the baseline characteristics are predicting the likelihood of attainment of HbA1c goal and changing in HbA1c after initiation of basal insulin glargine in insulin naïve people with type 2 diabetes not adequately controlled with oral glucose-lowering drugs. Iran-AFECT was a 24-week, prospective, multicenter, observational study of people with type 2 diabetes initiated or switched to insulin glargine. In this sub-analysis, we included all insulin naïve people. Glycemic response was defined as HbA1c≤7.0% and/or change in HbA1c at week 24. Data on 433 participants were included. The mean HbA1c was 8.9%±0.9% at baseline which decreased to 7.6%±1.2% (P<0.001). By week 24, 36% of the participants reached HbA1c≤7.0%. In univariate analysis, the strongest association was for the baseline HbA1c (r2=0.32, P<0.001). In multivariate analysis, predictors of change in HbA1c were baseline HbA1c (r2=0.29, P<0.001), and dosing of glargine (r2=0.01, P=0.02). The baseline HbA1c was accounting for 88% of explainable variances in HbA1c. The best cut-off predicting glycemic response for baseline HbA1c was 8.5%. Among factors predicting response to initiating basal insulin therapy with insulin glargine, baseline HbA1c is the strongest predictor explaining most of the variances in HbA1c change.
UK Prospective Diabetes Study (UKPDS) Group. Intensive bloodglucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.
Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-72.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-89.
Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabet Care 2009;32:193-203.
Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009;5:540-59.
Hermansen K, Davies M, Derezinski T, Martinez Ravn G, Clauson P, Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabet Care 2006;29:1269-74.
Riddle MC, Rosenstock J, Gerich J. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabet Care 2003;26:3080-6.
Schreiber SA, Ferlinz K, Haak T. The long-term efficacy of insulin glargine plus oral antidiabetic agents in a 32-month observational study of everyday clinical practice. Diabet Technol Therapeut 2008;10:121-7.
Raz I, Riddle MC, Rosenstock J, Buse JB, Inzucchi SE, Home PD, et al. Personalized management of hyperglycemia in type 2 diabetes: reflections from Diabetes Care Editors' Expert Forum. Diabet Care 2013;36:1779-88.
International Diabetes Federation. Global Guideline for Type 2 Diabetes,. 2012. (Accessed March 2017, 12, at http://www.idf.org/sites/default/files/IDF%20T2DM%20Guideline.pdf).
Owen V, Seetho I, Idris I. Predictors of responders to insulin therapy at 1 year among adults with type 2 diabetes. Diabet Obes Metab 2010;12:865-70.
Home PD, Shen C, Hasan MI, Latif ZA, Chen JW, Gonzalez Galvez G. Predictive and explanatory factors of change in HbA1c in a 24-week observational study of 66,726 people with type 2 diabetes starting insulin analogs. Diabet Care 2014;37:1237-45.
Riddle MC, Vlajnic A, Zhou R, Rosenstock J. Baseline HbA1c predicts attainment of 7.0% HbA1c target with structured titration of insulin glargine in type 2 diabetes: a patient-level analysis of 12 studies. Diabet Obes Metab 2013;15:819-25.
Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study. BMC Public Health 2005;5:36.
Angamo MT, Melese BH, Ayen WY. Determinants of glycemic control among insulin treated diabetic patients in Southwest Ethiopia: hospital based cross sectional study. PloS One 2013;8:e61759.
Nichols GA, Hillier TA, Javor K, Brown JB. Predictors of glycemic control in insulin-using adults with type 2 diabetes. Diabet Care 2000;23:273-7.
Nichols GA, Kimes TM, Harp JB, Kou TD, Brodovicz KG. Glycemic response and attainment of A1C goals following newly initiated insulin therapy for type 2 diabetes. Diabet Care 2012;35:495-7.
Garber A, Marre M, Blonde L, Allavoine T, Howlett H, Lehert P, et al. Influence of initial hyperglycaemia, weight and age on the blood glucose lowering efficacy and incidence of hypoglycaemic symptoms with a single-tablet metformin-glibenclamide therapy (Glucovance) in type 2 diabetes. Diabet Obes Metab 2003;5:171-9.
Retnakaran R, Hochman J, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V et al. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c. Diabet Care 2004;27:2590-6.
Chase HP, Arslanian S, White NH, Tamborlane WV. Insulin glargine versus intermediate-acting insulin as the basal component of multiple daily injection regimens for adolescents with type 1 diabetes mellitus. J Pediatr 2008;153:547-53.
McEwen LN, Bilik D, Johnson SL, Halter JB, Karter AJ, Mangione CM, et al. Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes: translating research into action for diabetes (TRIAD). Diabet Care 2009;32:971-6.
DeFronzo RA, Stonehouse AH, Han J, Wintle ME. Relationship of baseline HbA1c and efficacy of current glucose-lowering therapies: a meta-analysis of randomized clinical trials. Diabet Med 2010;27:309-17.
Liebl A, Jones S, Benroubi M, Castell C, Goday A, Aline Charles M, et al. Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries. Curr Med Res Opin 2011;27:887-95.
Home P, Naggar NE, Khamseh M, Gonzalez-Galvez G, Shen C, Chakkarwar P, et al. An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract 2011;94:352-63
| Files | ||
| Issue | Vol 55, No 9 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Diabetes mellitus Type 2 Hemoglobin A Glycosylated Basal insulin detemir | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
