Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA.

Blonde, Lawrence Meneghini, Luigi Peng, Xuejun Victor Boss, Anders Rhee, Kyu Shaunik, Alka Kumar, Supriya Balodi, Sidhartha Brulle-Wohlhueter, Claire McCrimmon, Rory J

REVIEW


07 June 2018

This study has substantial limitations as the authors have handpicked specific criteria in which to measure the outcomes. There are much better indicators of therapeutic inertia available than time. It seems that the authors merely picked on the time factor for the assessment because it is convenient and available.


RELEVANCE 2
INNOVATIVENESS 3
APPLICABILITY 2
OVERALL 2

PAPER DETAILS


TITLE

Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA.

ABSTRACT

INTRODUCTION
Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral antidiabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the USA.

METHODS
A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c < 7% if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months.

RESULTS
Our cohort was representative of patients with T2D who initiated BI from OADs in the USA. The average HbA1c was 9.1% at BI initiation, and decreased robustly (1.5%) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6% in Q2; 17.6% in Q3; 8.6% in Q4), and then remained low (≤ 6.1%) for each quarter in the second year. Cumulatively, about 38% of patients reached HbA1c < 7% in the first year; only approximately 8% more did so in the second year.

CONCLUSION
Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation.

FUNDING
Sanofi Corporation.



AUTHOR(S)

Blonde, Lawrence Meneghini, Luigi Peng, Xuejun Victor Boss, Anders Rhee, Kyu Shaunik, Alka Kumar, Supriya Balodi, Sidhartha Brulle-Wohlhueter, Claire McCrimmon, Rory J

JOURNAL

Diabetes therapy : research, treatment and education of diabetes and related disorders

PLACE

United States