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Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis
AIMS: To assess the effect of duration of hyperglycaemia before basal insulin (BI) initiation on clinical outcomes in type 2 diabetes (T2D). MATERIALS AND METHODS: Patients with T2D who initiated BI during 2009‐2013, had continuous enrolment for ≥2 years preceding and ≥1 year following BI initiation...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613234/ https://www.ncbi.nlm.nih.gov/pubmed/31294079 http://dx.doi.org/10.1002/edm2.61 |
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author | Raccah, Denis Guerci, Bruno Ajmera, Mayank Davis, Keith Meyers, Juliana Lew, Elisheva Shaunik, Alka Blonde, Lawrence |
author_facet | Raccah, Denis Guerci, Bruno Ajmera, Mayank Davis, Keith Meyers, Juliana Lew, Elisheva Shaunik, Alka Blonde, Lawrence |
author_sort | Raccah, Denis |
collection | PubMed |
description | AIMS: To assess the effect of duration of hyperglycaemia before basal insulin (BI) initiation on clinical outcomes in type 2 diabetes (T2D). MATERIALS AND METHODS: Patients with T2D who initiated BI during 2009‐2013, had continuous enrolment for ≥2 years preceding and ≥1 year following BI initiation (“index date”), and had ≥1 glycated haemoglobin (A1C) measure not at target (ie, ≥7.0%) within 6 months preindex date were included in the study. Patients were stratified by preindex‐date duration of A1C ≥7.0%. Longitudinal A1C, weight, BMI, and diabetes medication were compared between cohorts for up to 15‐month follow‐up. RESULTS: Of 37 053 patients who initiated BI, 40.7%, 15.3%, 16.0%, and 28.0%, respectively, had uncontrolled A1C for <6, 6‐<12, 12‐<18 and 18‐24 months preindex date. Baseline characteristics were similar between cohorts. Baseline A1C values were similar across cohorts (9.2%‐9.6%). Mean follow‐up A1C values were higher with longer preindex‐date duration of uncontrolled A1C (8.0 ± 1.7%, 8.2 ± 1.6%, 8.5 ± 1.7%, and 8.6 ± 1.7% for <6, 6‐<12, 12‐<18, and 18‐24 months); attainment of A1C <7.0% worsened with increasing preindex‐date duration of A1C ≥7.0% (29.6%, 20.0%, 14.6%, and 11.5% for <6, 6‐<12, 12‐<18, and 18‐24 months). CONCLUSIONS: These data suggest that longer duration of uncontrolled A1C before BI initiation increases the risk of not reaching glycaemic targets. However, target attainment was poor in all cohorts, highlighting inadequate glycaemic control as an important unmet need in US patients with T2D. |
format | Online Article Text |
id | pubmed-6613234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-66132342019-07-10 Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis Raccah, Denis Guerci, Bruno Ajmera, Mayank Davis, Keith Meyers, Juliana Lew, Elisheva Shaunik, Alka Blonde, Lawrence Endocrinol Diabetes Metab Original Articles AIMS: To assess the effect of duration of hyperglycaemia before basal insulin (BI) initiation on clinical outcomes in type 2 diabetes (T2D). MATERIALS AND METHODS: Patients with T2D who initiated BI during 2009‐2013, had continuous enrolment for ≥2 years preceding and ≥1 year following BI initiation (“index date”), and had ≥1 glycated haemoglobin (A1C) measure not at target (ie, ≥7.0%) within 6 months preindex date were included in the study. Patients were stratified by preindex‐date duration of A1C ≥7.0%. Longitudinal A1C, weight, BMI, and diabetes medication were compared between cohorts for up to 15‐month follow‐up. RESULTS: Of 37 053 patients who initiated BI, 40.7%, 15.3%, 16.0%, and 28.0%, respectively, had uncontrolled A1C for <6, 6‐<12, 12‐<18 and 18‐24 months preindex date. Baseline characteristics were similar between cohorts. Baseline A1C values were similar across cohorts (9.2%‐9.6%). Mean follow‐up A1C values were higher with longer preindex‐date duration of uncontrolled A1C (8.0 ± 1.7%, 8.2 ± 1.6%, 8.5 ± 1.7%, and 8.6 ± 1.7% for <6, 6‐<12, 12‐<18, and 18‐24 months); attainment of A1C <7.0% worsened with increasing preindex‐date duration of A1C ≥7.0% (29.6%, 20.0%, 14.6%, and 11.5% for <6, 6‐<12, 12‐<18, and 18‐24 months). CONCLUSIONS: These data suggest that longer duration of uncontrolled A1C before BI initiation increases the risk of not reaching glycaemic targets. However, target attainment was poor in all cohorts, highlighting inadequate glycaemic control as an important unmet need in US patients with T2D. John Wiley and Sons Inc. 2019-03-28 /pmc/articles/PMC6613234/ /pubmed/31294079 http://dx.doi.org/10.1002/edm2.61 Text en © 2019 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles Raccah, Denis Guerci, Bruno Ajmera, Mayank Davis, Keith Meyers, Juliana Lew, Elisheva Shaunik, Alka Blonde, Lawrence Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title | Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title_full | Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title_fullStr | Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title_full_unstemmed | Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title_short | Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis |
title_sort | clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: an electronic medical record database analysis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613234/ https://www.ncbi.nlm.nih.gov/pubmed/31294079 http://dx.doi.org/10.1002/edm2.61 |
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