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Treat-to-target trials: uses, interpretation and review of concepts
Treat-to-target trial designs compare investigational insulins with a standard insulin. Treat-to-target trials force-titrate insulin dosages to achieve a prespecified treatment goal. With comparable glycaemic control, comparisons of safety endpoints such as hypoglycaemia can be made to establish the...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237121/ https://www.ncbi.nlm.nih.gov/pubmed/23668598 http://dx.doi.org/10.1111/dom.12129 |
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author | Garber, A J |
author_facet | Garber, A J |
author_sort | Garber, A J |
collection | PubMed |
description | Treat-to-target trial designs compare investigational insulins with a standard insulin. Treat-to-target trials force-titrate insulin dosages to achieve a prespecified treatment goal. With comparable glycaemic control, comparisons of safety endpoints such as hypoglycaemia can be made to establish the risk-benefit profile of the new insulin. Glargine versus NPH showed comparable A1C reductions; however, A1C <7% without associated nocturnal hypoglycaemia was reached in more patients on glargine and overall hypoglycaemia was lower. Detemir versus glargine showed non-inferiority between the groups; however, with less weight gain and more injection site reactions with detemir. Detemir/aspart versus glargine/aspart showed non-inferiority between the treatments, however, with less weight gain in the detemir group but comparable risk of hypoglycaemia. Degludec in combination with aspart versus glargine/aspart showed comparable A1C reductions. However, degludec-treated patients had less overall hypoglycaemia and less nocturnal hypoglycaemia. Because insulin titrations are guided by goal attainment with each treatment, treat-to-target trials enable clinicians to determine differences in non-glycaemic treatment effects, such as rates of hypoglycaemia and weight gain, at the same level of glycaemic control. |
format | Online Article Text |
id | pubmed-4237121 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-42371212014-12-15 Treat-to-target trials: uses, interpretation and review of concepts Garber, A J Diabetes Obes Metab Review Articles Treat-to-target trial designs compare investigational insulins with a standard insulin. Treat-to-target trials force-titrate insulin dosages to achieve a prespecified treatment goal. With comparable glycaemic control, comparisons of safety endpoints such as hypoglycaemia can be made to establish the risk-benefit profile of the new insulin. Glargine versus NPH showed comparable A1C reductions; however, A1C <7% without associated nocturnal hypoglycaemia was reached in more patients on glargine and overall hypoglycaemia was lower. Detemir versus glargine showed non-inferiority between the groups; however, with less weight gain and more injection site reactions with detemir. Detemir/aspart versus glargine/aspart showed non-inferiority between the treatments, however, with less weight gain in the detemir group but comparable risk of hypoglycaemia. Degludec in combination with aspart versus glargine/aspart showed comparable A1C reductions. However, degludec-treated patients had less overall hypoglycaemia and less nocturnal hypoglycaemia. Because insulin titrations are guided by goal attainment with each treatment, treat-to-target trials enable clinicians to determine differences in non-glycaemic treatment effects, such as rates of hypoglycaemia and weight gain, at the same level of glycaemic control. Blackwell Publishing Ltd 2014-03 2013-06-14 /pmc/articles/PMC4237121/ /pubmed/23668598 http://dx.doi.org/10.1111/dom.12129 Text en © 2013 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
spellingShingle | Review Articles Garber, A J Treat-to-target trials: uses, interpretation and review of concepts |
title | Treat-to-target trials: uses, interpretation and review of concepts |
title_full | Treat-to-target trials: uses, interpretation and review of concepts |
title_fullStr | Treat-to-target trials: uses, interpretation and review of concepts |
title_full_unstemmed | Treat-to-target trials: uses, interpretation and review of concepts |
title_short | Treat-to-target trials: uses, interpretation and review of concepts |
title_sort | treat-to-target trials: uses, interpretation and review of concepts |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237121/ https://www.ncbi.nlm.nih.gov/pubmed/23668598 http://dx.doi.org/10.1111/dom.12129 |
work_keys_str_mv | AT garberaj treattotargettrialsusesinterpretationandreviewofconcepts |