Composite HbA1c End Point Can Better Gauge Response to Basal Insulin in Type 2 Diabetes

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A composite HbA1c end point identified 34% more responders than a single HbA1c end point.
A composite HbA1c end point identified 34% more responders than a single HbA1c end point.

A composite glycated hemoglobin (HbA1c) end point is superior to the single HbA1c measure to better recognize response to basal insulin in insulin-naive people with type 2 diabetes (T2D), according to findings from a new study published in Clinical Diabetes and Endocrinology.

Research has recently shown that a composite HbA1c can identify more patients with clinically meaningful responses to insulin therapy compared with reaching a target HbA1c alone. In the current study, the investigators aimed to identify baseline/clinical characteristics that were associated with clinically meaningful responses to treatment with insulin glargine 100 U/mL at 24 weeks.

Data on participants were pooled from 3 randomized trials, and responders were defined as achieving end point HbA1c target <53 mmol/mol (<7%) and/or ≥11 mmol/mol (≥1%) HbA1c reduction from baseline. The baseline characteristics of responders (n=1188) and nonresponders (n=297) at 24 weeks were generally similar but there were some important differences.

Responders had higher baseline HbA1c (mean 99 vs 91 mmol/mol [9.1 vs 8.3%]; P <.001), higher fasting blood glucose (10.4 vs 8.8 mmol/L [187 vs 159 mg/dL]; P <.001), and fewer individuals (94% vs 98%; P =.006) used oral medications that targeted postprandial blood glucose.

Response at 12 weeks was a strong predictor of subsequent 24-week responses (sensitivity 85.9%; predictive positive value 91.4%), and at both 12 and 24 weeks <40% of responders and nonresponders had been able to achieve a target fasting blood glucose of ≤5.6 mmol/L (≤100 mg/dL).

Other results showed that individuals who responded at 24 weeks had a higher incidence of hypoglycemia (82.5% vs 70.4%; P <.001), nocturnal hypoglycemia (60.3% vs 50.5%; P =.002), and documented symptomatic hypoglycemia (65.8% vs 55.6%; P <.001) vs nonresponders.

“Our findings confirm the clinical utility of [insulin glargine 100 U/mL] as a safe and effective starter basal insulin and offer insights about addressing an individual's response to treatment as early as 12 weeks,” wrote the researchers.

Reference

Cummings MH, Cao D, Hadjiyianni I, Ilag LL, Tan MH. Characteristics of insulin-naïve people with type 2 diabetes who successfully respond to insulin glargine U100 after 24 weeks of treatment: a meta-analysis of individual participant data from 3 randomized clinical trials. Clin Diabetes Endocrinol. 2018;4:10.

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