Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations. Issue 3 (24th February 2016)

• Record Type: Journal Article
• Authors: Orozco‐Beltran, D.; Pan, C.; Svendsen, A. L.; Færch, L.; Caputo, S.
• Is Part Of: International journal of clinical practice. Volume 70:Issue 3(2016)
• Page Start: 236
• Page End: 243
• Publication Date: 2016-02-24
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.12776
• Languages: English
• ISSNs: 1368-5031

Abstract

Summary: Objective: To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. Research design and methods: Study of Once‐Daily Levemir (SOLVE ™ ) is an international, 24‐week, observational study of insulin initiation in people with type 2 diabetes. Results: A total of 17, 374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) −1.2 ± 1.4% (−13.1 ± 15.3 mmol/mol) and −1.3 ± 1.6% (−14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [−0.04%, 95% confidence interval (CI) −0.09 to −0.01 (−0.4 mmol/mol, 95% CI −1.0−0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06–0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64–0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). Conclusions: Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.