Philip D Home1, Marie-Paule Dain2, Nick Freemantle3, Ryuzo Kawamori4, Martin Pfohl5, Sandrine Brette6, Valérie Pilorget2, Werner A Scherbaum7, Giacomo Vespasiani8, Maya Vincent2, Beverley Balkau9. 1. Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: philip.home@ncl.ac.uk. 2. Sanofi, Paris, France. 3. Department of Primary Care and Population Health, University College London, United Kingdom. 4. Department of Medicine, Juntendo University, Tokyo, Japan. 5. Evangelisches Bethesda-Krankenhaus zu Duisburg GmbH, Duisburg, Germany. 6. Lincoln, Boulogne-Billancourt, France. 7. Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany. 8. Diabetology and Metabolic Disorders Centre, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy. 9. INSERM, U1018, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France.
Abstract
AIMS: It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning. METHODS: People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years. RESULTS: Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22]mmol/mol) and BMI 29.3 (6.3)kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime+basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2U/day at the start and 45.8U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24]mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5)kg at year 4. CONCLUSION: Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.
AIMS: It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning. METHODS:People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years. RESULTS: Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22]mmol/mol) and BMI 29.3 (6.3)kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime+basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2U/day at the start and 45.8U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24]mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5)kg at year 4. CONCLUSION: Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.
Authors: Dario Giugliano; Paolo Chiodini; Maria Ida Maiorino; Giuseppe Bellastella; Katherine Esposito Journal: Endocrine Date: 2015-08-18 Impact factor: 3.633
Authors: Philip Home; Matthew Riddle; William T Cefalu; Clifford J Bailey; Reinhard G Bretzel; Stefano Del Prato; Derek Leroith; Guntram Schernthaner; Luc van Gaal; Itamar Raz Journal: Diabetes Care Date: 2014-06 Impact factor: 19.112
Authors: Peter Bramlage; Tobias Bluhmki; Holger Fleischmann; Matthias Kaltheuner; Jan Beyersmann; Reinhard W Holl; Thomas Danne Journal: BMJ Open Diabetes Res Care Date: 2017-01-25