Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

AIMS: To evaluate short‐ and long‐term glycaemic control and hypoglycaemia incidence in insulin‐naïve patients ≥30 years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti‐hyperglycaemic drugs (OADs). METHODS: This was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short‐term (0‐3 months post BI initiation) factors associated with long‐term (3‐24 months) glycaemic control and hypoglycaemia. RESULTS: Overall, 40 627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24 months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3 months was associated with increased risk of failing to achieve target at 24 months (odds ratio [OR], 3.70 [95% CI, 3.41‐4.00]). Over 24 months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3‐month period was associated with longer‐term risk of these events over the ensuing 3 to 24 months (OR, 5.71 [95% CI, 4.67‐6.99]). CONCLUSIONS: Initiating BI with or without OADs is associated with short‐ and long‐term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3 months, or after 2 years of BI treatment. Treatment response and hypoglycaemia incidence by 3 months post BI initiation are associated with longer‐term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti‐hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.