scholarly journals Glycaemic impact of treatment intensification in patients with type 2 diabetes uncontrolled with oral antidiabetes drugs or basal insulin

2018 ◽  
Vol 1 (3) ◽  
pp. e00019 ◽  
Author(s):  
Erin K. Buysman ◽  
Tao Fan ◽  
Cori Blauer-Peterson ◽  
Lesley-Ann Miller-Wilson
Keyword(s):  
Type 2 Diabetes ◽  
Basal Insulin ◽  
Treatment Intensification ◽  
Oral Antidiabetes Drugs

Clinical Predictors of the Need for Further Treatment Escalation in Patients with Type 2 Diabetes on Basal Insulin Therapy – A Retrospective Observational Study

2019 ◽  
Vol 127 (10) ◽  
pp. 663-671
Author(s):  
Christina Buchholz ◽  
Melanie Kahle-Stephan ◽  
Juris J. Meier ◽  
Michael A. Nauck
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Plasma Glucose ◽  
Basal Insulin ◽  
Target Range ◽  
Diabetic Patients ◽  
Treatment Intensification ◽  
Oral Agents ◽  
Glucose Profiles

Abstract Background/Aims The aim of this study was to identify clinical characteristics that distinguish patients who achieve sufficient glycaemic control with basal insulin and oral glucose-lowering medications from those who need treatment intensification. Patients/Methods 213 out of 1 042 consecutively hospitalized type 2-diabetic patients were treated with basal insulin/oral agents. After titration to fasting glucose target, in 156 patients (73.2%) continuation of basal insulin treatment was recommended, while in 57 (26.8%), intensification of treatment was necessary. We compared patients’ characteristics and plasma glucose profiles between these groups. Results Patients needing intensified regimens (basal-bolus regimes, premixed insulin ;GLP-1 receptor agonists) had higher initial HbA1c values (87±17 mmol/mol [10.1±1.7%] vs. 80±19 mmol/mol [9.5±1.9%], p=0.028), were more likely to be female (49.1 vs. 25.0%, p=0.0014) and more obese, and required higher basal insulin doses (62±40 vs. 39±27 IU/d, p<0.0001). In both patient groups, basal insulin reduced fasting plasma glucose into the target range (6.6±1.3 vs. 5.7±0.8 mmol/l), however, in those needing treatment intensification, post-breakfast plasma glucose remained substantially higher after basal insulin titration (12.6±2.0 vs.9.4±1.6 mmol/l, p<0.0001). Before hospital discharge, similar plasma glucose profiles were reached in both groups. Conclusions Basal insulin therapy can provide satisfactory glucose control in more than 70% of patients with type 2 diabetes. Long diabetes duration, obesity, insulin resistance and female sex indicate a need for further treatment intensification.

PREDICTORS AND CLINICAL OUTCOMES OF TREATMENT INTENSIFICATION IN PATIENTS WITH TYPE 2 DIABETES UNCONTROLLED ON BASAL INSULIN IN A REAL-WORLD SETTING

2018 ◽  
Vol 24 (9) ◽  
pp. 805-814 ◽  
Author(s):  
Lee Kallenbach ◽  
Amy M. Shui ◽  
Wendy Y. Cheng ◽  
Tao Fan ◽  
Wenli Hu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Outcomes ◽  
Real World ◽  
Basal Insulin ◽  
Treatment Intensification ◽  
Real World Setting
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