Achieving Glycemic Control in T2D After Basal Insulin Initiation

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The average HbA1c was 9.1% at basal insulin initiation and decreased 1.5% in the first 6 months after initiation with no further reductions thereafter.
The average HbA1c was 9.1% at basal insulin initiation and decreased 1.5% in the first 6 months after initiation with no further reductions thereafter.

Achievement of glycemic control after initiating basal insulin (BI) therapy may diminish over time in patients with type 2 diabetes (T2D) and may remain low after 12 months of therapy, according to a brief report published in Diabetes Therapy.

Researchers conducted a retrospective observational study of data extracted from the electronic medical records of 6597 patients with T2D who had hemoglobin A1c (HbA1c) levels recorded 90 days prior to and 24 months after the initiation of BI. The mean baseline HbA1c of participants was 9.1%, with 49% of participants having values >9.0%.

Follow-up of patients included in this study continued until 2 years after BI initiation or until database cut-off date for the analysis. The purpose of the study was to evaluate the effectiveness of BI on the achievement of glycemic control over the course of 24 months after initiation in patients with T2D.

Study results showed the mean decrease in HbA1c from baseline to 6 months after initiation was 1.49, but with no further reductions occurred after that point. The probability of achieving the first glycemic control in the second, third, and fourth quarters after initiation of BI were found to be 26.6%, 17.6%, and 8.6%, respectively. Researchers found the probability of achieving glycemic control after BI initiation diminished to ≤6.1% during any quarter after the second year.

The percentage of patients who achieved their first HbA1c level <7% by 6, 12, 18, and 24 months were 25%, 38%, 42%, and 46%, respectively. Therefore, during the first year, 38% of participants achieved glycemic control, with only an additional 8% achieving glycemic control during the second year.

Researchers concluded that the likelihood of newly achieving glycemic control diminished over time in individuals who initiated BI after the use of oral antidiabetic medications. Further, if patients do not achieve glycemic control within 3 months of initiation, researchers recommend a change in treatment, as there is very little benefit in maintaining a BI regimen over 12 to 24 months without reaching HbA1c <7%.

Clinicians should follow individuals with T2D carefully during the first 12 months after initiation of BI and should consider making medication changes if glycemic control is not achieved within 12 months of BI initiation.

Reference

Blonde L, Meneghini L, Peng XV, et al. Probability of achieving glycemic control with basal insulin in patients with type 2 diabetes in real-world practice in the USA [published online March 29, 2018]. Diabetes Ther. doi: 10.1007/s13300-018-0413-5

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