Effectiveness of intensification therapies in Danes with Type 2 diabetes who use basal insulin: a population‐based study. Issue 2 (9th July 2016)

• Record Type: Journal Article
• Authors: Thomsen, R. W.; Baggesen, L. M.; Søgaard, M.; Pedersen, L.; Nørrelund, H.; Buhl, E. S.; Haase, C. L.; Johnsen, S. P.
• Is Part Of: Diabetic medicine. Volume 34:Issue 2(2017)
• Page Start: 213
• Page End: 222
• Publication Date: 2016-07-09
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13168
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To examine the usage and real‐life effectiveness of intensification therapies in people with Type 2 diabetes treated with basal insulin. Methods: We used population‐based healthcare databases in Denmark during 2000–2012 to identify all individuals with a first basal insulin prescription (with or without oral drugs), and evaluated subsequent intensification therapy with bolus insulin, premixed insulin or glucagon‐like peptide‐1 (GLP‐1) receptor agonists. Poisson regression was used to compute the adjusted relative risks of reaching glycaemic control targets. Results: We included 7034 initiators of basal insulin (median age 64 years, diabetes duration 5.3 years, 84% with oral co‐medication and median (interquartile range) pre‐insulin HbA1c level 77 (65–92) mmol/mol [9.2% (8.1–10.6%)]. Of these, 3076 (43.7%) received intensification therapy after a median of 11 months: 58.5% with premixed insulin, 29.0% with bolus insulin, 10.6% with GLP‐1 receptor agonists, and 1.9% with more than one add‐on. Overall, 22% had attained an HbA1c level of < 53 mmol/mol (< 7%) by 3–6 months after intensification, while 38% attained an HbA1c < 58 mmol/mol (< 7.5%). Compared with premixed insulin intensification, attainment of HbA1c < 53 and < 58 mmol/mol was similar with bolus insulin add‐on [adjusted relative risk 1.03 (95% CI 0.86–1.24) and 1.02 (95% CI 0.91–1.15), and higher for GLP‐1 receptor agonist add‐on [adjusted relative risk 1.56 (95% CI 1.27–1.92) and 1.27 (1.10–1.47)]. Conclusions: Among people with Type 2 diabetes, 22 and 38% reached a target HbA1c < 53 mmol/mol (< 7%) or < 58 mmol/mol (< 7.5%), respectively, after intensification of their basal insulin therapy. Compared with premixed insulin, target attainment was similar with bolus insulin and higher with GLP‐1 receptor agonists. What's new?: Among people with Type 2 diabetes treated in routine clinical practice, 22% attained a target HbA1c value of < 53 mmol/mol (< 7%) and 38% attained an HbA1c of < 58 mmol/mol (< 7.5%) 3–6 months after intensification of their basal insulin therapy. Compared with intensification with premixed insulin, target attainment was similar with bolus insulin and higher with glucagon‐like peptide‐1 receptor agonists.