Effectiveness of intensification therapies in Danes with Type 2 diabetes who use basal insulin: a population‐based study

Aims To examine the usage and real‐life effectiveness of intensification therapies in people with Type 2 diabetes treated with basal insulin. Methods We used population‐based healthcare databases in Denmark during 2000–2012 to identify all individuals with a first basal insulin prescription (with or...

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Bibliographic Details
Published in:Diabetic medicine 2017-02, Vol.34 (2), p.213-222
Main Authors: Thomsen, R. W., Baggesen, L. M., Søgaard, M., Pedersen, L., Nørrelund, H., Buhl, E. S., Haase, C. L., Johnsen, S. P.
Format: Article
Language:English
Subjects:
Aged
Blood Glucose - metabolism
Databases, Factual
Denmark
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - metabolism
Drug development
Drug Therapy, Combination
Female
Glucagon
Glucagon-like peptide 1
Glucagon-Like Peptide-1 Receptor - agonists
Glycated Hemoglobin A - metabolism
Humans
Hypoglycemic Agents - administration & dosage
Incretins - administration & dosage
Insulin
Insulin - administration & dosage
Male
Middle Aged
Population studies
Population-based studies
Pumps
Retrospective Studies
Risk assessment
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Summary:Aims To examine the usage and real‐life effectiveness of intensification therapies in people with Type 2 diabetes treated with basal insulin. Methods We used population‐based healthcare databases in Denmark during 2000–2012 to identify all individuals with a first basal insulin prescription (with or without oral drugs), and evaluated subsequent intensification therapy with bolus insulin, premixed insulin or glucagon‐like peptide‐1 (GLP‐1) receptor agonists. Poisson regression was used to compute the adjusted relative risks of reaching glycaemic control targets. Results We included 7034 initiators of basal insulin (median age 64 years, diabetes duration 5.3 years, 84% with oral co‐medication and median (interquartile range) pre‐insulin HbA1c level 77 (65–92) mmol/mol [9.2% (8.1–10.6%)]. Of these, 3076 (43.7%) received intensification therapy after a median of 11 months: 58.5% with premixed insulin, 29.0% with bolus insulin, 10.6% with GLP‐1 receptor agonists, and 1.9% with more than one add‐on. Overall, 22% had attained an HbA1c level of < 53 mmol/mol (< 7%) by 3–6 months after intensification, while 38% attained an HbA1c < 58 mmol/mol (< 7.5%). Compared with premixed insulin intensification, attainment of HbA1c < 53 and < 58 mmol/mol was similar with bolus insulin add‐on [adjusted relative risk 1.03 (95% CI 0.86–1.24) and 1.02 (95% CI 0.91–1.15), and higher for GLP‐1 receptor agonist add‐on [adjusted relative risk 1.56 (95% CI 1.27–1.92) and 1.27 (1.10–1.47)]. Conclusions Among people with Type 2 diabetes, 22 and 38% reached a target HbA1c < 53 mmol/mol (< 7%) or < 58 mmol/mol (< 7.5%), respectively, after intensification of their basal insulin therapy. Compared with premixed insulin, target attainment was similar with bolus insulin and higher with GLP‐1 receptor agonists. What's new? Among people with Type 2 diabetes treated in routine clinical practice, 22% attained a target HbA1c value of < 53 mmol/mol (< 7%) and 38% attained an HbA1c of < 58 mmol/mol (< 7.5%) 3–6 months after intensification of their basal insulin therapy. Compared with intensification with premixed insulin, target attainment was similar with bolus insulin and higher with glucagon‐like peptide‐1 receptor agonists.
ISSN:0742-3071
1464-5491
DOI:10.1111/dme.13168