Effects of basal and premixed insulin on glycemic control in type 2 diabetes patients based on multicenter prospective real‐world data. Issue 2 (13th January 2022)

• Record Type: Journal Article
• Authors: Peng, Ying; Xu, Peihong; Shi, Juan; Zhang, Yifei; Wang, Shujie; Zheng, Qidong; Wang, Yufan; Ke, Tingyu; Li, Li; Zhao, Dong; Dai, Yuancheng; Dong, Qijuan; Ji, Bangqun; Xu, Fengmei; Gu, Weiqiong; Wang, Weiqing
• Is Part Of: Journal of diabetes. Volume 14:Issue 2(2022)
• Page Start: 134
• Page End: 143
• Publication Date: 2022-01-13
• Subjects: basal insulin -- body mass index -- glycemic hemoglobin -- premixed insulin -- type 2 diabetes; 型糖尿病 -- 预混胰岛素 -- 基础胰岛素 -- 糖化血红蛋白 -- 体重指数; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.13245
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: To investigate the different efficacies of glycemic control between basal and premixed insulin in participants with type 2 diabetes (T2DM) when non‐insulin medications fail to reach treatment targets. Methods: This was a prospective, large‐scale, real‐world study at 10 diabetes centers in China. Between June 2017 and June 2021, we enrolled 1104 T2DM participants initiated with either once‐daily basal insulin or twice‐daily premixed insulin when the glycosylated hemoglobin (HbA1c) control target was not met after at least two non‐insulin agents were administered. A Cox proportional hazards regression model adjusting for multiple influencing factors was performed to compare the different effects of basal and premixed insulin on reaching the HbA1c control target. Results: At baseline, basal insulin (57.3%) was prescribed more frequently than premixed insulin (42.7%). Patients with a higher body mass index (BMI) or higher HbA1c levels were more likely to receive premixed insulin than basal insulin (both p < 0.001). After a median follow‐up of 12.0 months, compared to those with premixed insulin, the hazard ratio for reaching the HbA1c target to those with basal insulin was 1.10 (95% CI, 0.92‐1.31; p = 0.29) after adjustment, and less weight gain was observed in those with basal insulin than with premixed insulin (percentage change of BMI from baseline −0.37[5.50]% vs 3.40[6.73]%, p < 0.0001). Conclusions: In this real‐world study, once‐daily basal insulin was more frequently prescribed and had similar glycemic control effects but less weight gain compared with twice‐daily premixed insulin when used as initiation therapy for those in whom glycemic control with non‐insulin medications failed. Abstract : Highlights In real‐world practice in China, once‐daily basal insulin was prescribed more often than twice‐daily premixed insulin to type 2 diabetes patients uncontrolled with non‐insulin medications. Treatment with once‐daily basal insulin showed similar effects on reaching glycosylated hemoglobin targets compared with twice‐daily premixed insulin, even after stratification by multiple influencing factors. Less weight gain was observed in those treated with basal insulin than in those treated with premixed insulin, which might be at least partially attributed to the lower insulin dosage administered in the former group. 摘要: 背景: 探究当非胰岛素降糖药物不能达到控制目标时, 基础胰岛素和预混胰岛素对2型糖尿病(T2DM)患者血糖控制的疗效差异。 方法: 这是一项在中国10个糖尿病中心进行的前瞻性大规模真实世界研究。在2017年6月至2021年6月期间, 我们共纳入了1104位2型糖尿病患者, 均在使用至少两种非胰岛素降糖药治疗时糖化血红蛋白(HbA1c)未达标后开始启用每天一次基础胰岛素或每天两次预混胰岛素治疗。采用Cox比例风险回归模型矫正多个影响因素, 比较基础胰岛素和预混合胰岛素对HbA1c控制的效果。 结果: 基线数据显示, 基础胰岛素的处方频率(57.3%)高于预混胰岛素(42.7%)。体重指数(BMI)或HbA1c水平较高的患者接受预混胰岛素治疗的可能性高于基础胰岛素(P<0.001)。经过中位12个月的随访, 与预混胰岛素组相比, 校正后的基础胰岛素组患者HbA1c达标的风险比(95%CI)为1.10(0.92‐1.31, P=0.29), 而体重增加的程度相对较小(BMI增加百分比为‐0.37[5.50]% vs. 3.40[6.73]%, P<0.0001)。 结论: 在这项真实世界研究中, 在使用非胰岛素降糖药物血糖控制失败后作为起始治疗时, 每日一次的基础胰岛素与每日两次预混胰岛素治疗方案相比, 前者更为常用。两者虽具有相似的血糖控制效果, 但每日一次的基础胰岛素治疗体重增加更少。