Effectiveness of premixed insulin to achieve glycaemic control in type 2 diabetes: A retrospective UK cohort study. Issue 4 (26th January 2021)

• Record Type: Journal Article
• Authors: Jude, Edward B.; Trescoli, Carlos; Emral, Rifat; Ali, Amar; Lubwama, Robert; Palmer, Karen; Shaunik, Alka; Nanda, Nithya; Raskin, Philip; Gomez‐Peralta, Fernando
• Is Part Of: Diabetes, obesity & metabolism. Volume 23:Issue 4(2021)
• Page Start: 929
• Page End: 937
• Publication Date: 2021-01-26
• Subjects: database research, glycaemic control, insulin therapy, type 2 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14298
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: To investigate the effectiveness of premixed insulin for achieving glycaemic outcomes in clinical practice in the UK. Materials and Methods: Electronic medical record data from The Health Improvement Network database were captured for adults with type 2 diabetes (T2D) uncontrolled (HbA1c ≥9%) on two or more oral antihyperglycaemic drugs (OADs) initiating premixed insulin. Effectiveness of premixed insulin was assessed by the probability and incidence of achieving glycaemic outcomes (target HbA1c <7.5% [<58 mmol/mol] and a ≥1% or ≥2% HbA1c reduction) over 24 months. Results: Data from 974 participants (mean age 62 years; 56% male; 52% obese or extremely obese; mean HbA1c 11.3% [100 mmol/mol]; hypertension 64%, dyslipidaemia 23% and nephropathy 21%) were analysed. The probability of achieving HbA1c <7.5% was highest during months 3‐6 (18.2%), while the cumulative probability of achieving this target plateaued between months 15‐24 (15.7%‐16.0%). Incidence of achieving all glycaemic outcomes plateaued after 12 months and differed by baseline HbA1c, but not OAD use. Factors affecting some glycaemic outcomes included a body mass index >40 kg/m 2 and co‐morbidities including nephropathy and stroke. Conclusions: In people with uncontrolled T2D (HbA1c ≥9%), glycaemic outcome achievement on premixed insulin was low at 6 months with little additional clinical benefit beyond 12 months, suggesting a high unmet need for early, timely treatment changes with more effective, simpler therapies.