Cargando…

Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

OBJECTIVE: To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. RESEARCH DESIGN AND METHODS: Study of Once‐Daily Levemir (SOLVE (™)) is an international, 24‐week, observational study of insulin initiation in people...

Descripción completa

Detalles Bibliográficos
Autores principales: Orozco‐Beltran, D., Pan, C., Svendsen, A. L., Færch, L., Caputo, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832583/
https://www.ncbi.nlm.nih.gov/pubmed/26916450
http://dx.doi.org/10.1111/ijcp.12776
_version_ 1782427278875033600
author Orozco‐Beltran, D.
Pan, C.
Svendsen, A. L.
Færch, L.
Caputo, S.
author_facet Orozco‐Beltran, D.
Pan, C.
Svendsen, A. L.
Færch, L.
Caputo, S.
author_sort Orozco‐Beltran, D.
collection PubMed
description OBJECTIVE: To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. RESEARCH DESIGN AND METHODS: Study of Once‐Daily Levemir (SOLVE (™)) is an international, 24‐week, observational study of insulin initiation in people with type 2 diabetes. RESULTS: A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) −1.2 ± 1.4% (−13.1 ± 15.3 mmol/mol) and −1.3 ± 1.6% (−14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [−0.04%, 95% confidence interval (CI) −0.09 to −0.01 (−0.4 mmol/mol, 95% CI −1.0−0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06–0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64–0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). CONCLUSIONS: Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.
format Online
Article
Text
id pubmed-4832583
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-48325832016-04-27 Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations Orozco‐Beltran, D. Pan, C. Svendsen, A. L. Færch, L. Caputo, S. Int J Clin Pract Endocrinology and Metabolism OBJECTIVE: To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. RESEARCH DESIGN AND METHODS: Study of Once‐Daily Levemir (SOLVE (™)) is an international, 24‐week, observational study of insulin initiation in people with type 2 diabetes. RESULTS: A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) −1.2 ± 1.4% (−13.1 ± 15.3 mmol/mol) and −1.3 ± 1.6% (−14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [−0.04%, 95% confidence interval (CI) −0.09 to −0.01 (−0.4 mmol/mol, 95% CI −1.0−0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06–0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64–0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). CONCLUSIONS: Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation. John Wiley and Sons Inc. 2016-02-24 2016-02-26 /pmc/articles/PMC4832583/ /pubmed/26916450 http://dx.doi.org/10.1111/ijcp.12776 Text en © 2016 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) 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 Endocrinology and Metabolism
Orozco‐Beltran, D.
Pan, C.
Svendsen, A. L.
Færch, L.
Caputo, S.
Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title_full Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title_fullStr Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title_full_unstemmed Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title_short Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
title_sort basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
topic Endocrinology and Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832583/
https://www.ncbi.nlm.nih.gov/pubmed/26916450
http://dx.doi.org/10.1111/ijcp.12776
work_keys_str_mv AT orozcobeltrand basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations
AT panc basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations
AT svendsenal basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations
AT færchl basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations
AT caputos basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations
AT basalinsulininitiationinprimaryvsspecialistcaresimilarglycaemiccontrolintwodifferentpatientpopulations