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. Issue 9 (5th April 2013)

• Record Type: Journal Article
• Authors: Riddle, M. C.; Vlajnic, A.; Zhou, R.; Rosenstock, J.
• Is Part Of: Diabetes, obesity & metabolism. Volume 15:Issue 9(2013:Sep.)
• Page Start: 819
• Page End: 825
• Publication Date: 2013-04-05
• Subjects: Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.12096
• Languages: English
• ISSNs: 1462-8902

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="dom12096-sec-0001" sec-type="section"> <title>Aims</title> <p>To determine whether baseline characteristics, especially haemoglobin A1c (HbA1c), predict the likelihood of reaching HbA1c ≤ 7.0% or the risk of experiencing hypoglycaemia after the addition of insulin glargine to oral therapy in type 2 diabetes.</p> </sec> <sec id="dom12096-sec-0002" sec-type="section"> <title>Methods</title> <p>Pooled patient‐level data from 12 prospective, randomized, controlled studies that used insulin glargine in a treat‐to‐target titration regimen seeking fasting glucose levels ≤5.5 mmol/l (100 mg/dl) were analysed. Baseline characteristics were evaluated by logistic regression models as predictors of reaching a target HbA1c ≤ 7.0% or experiencing confirmed hypoglycaemia. The effect of prior glycaemic control was further explored by analysis of categorical ranges of baseline HbA1c.</p> </sec> <sec id="dom12096-sec-0003" sec-type="section"> <title>Results</title> <p>Of 2312 participants, 95% completed 24 weeks of treatment. Lower HbA1c at baseline was independently associated with reaching HbA1c target [adjusted odds ratio (OR) for 1% difference: 0.538, p < 0.0001] and also with likelihood of experiencing confirmed hypoglycaemic events (adjusted OR: 0.835, p < 0.0001) at week 24. In an unadjusted analysis by baseline HbA1c range, the strong association between baseline control and attaining target HbA1c was confirmed (75% with baseline HbA1c < 8.0%, 60% with baseline HbA1c ≥ 8.0 and <9.0% and 38% with baseline HbA1c ≥ 9.0% attained HbA1c ≤ 7.0%). The incidence of hypoglycaemia confirmed <3.9 mmol/l (70 mg/dl) was higher in the lower baseline HbA1c ranges but severe hypoglycaemia was infrequent at all baseline HbA1c levels.</p> </sec> <sec id="dom12096-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Systematically titrated insulin glargine, added to oral agents, was effective over a wide range of baseline HbA1c. Lower baseline HbA1c was the best clinical predictor of achieving HbA1c ≤ 7.0% and also associated with higher risk of glucose‐confirmed hypoglycaemia. Severe hypoglycaemia was infrequent using this treatment approach.</p> </sec> </abstract>