Safety of once-daily insulin detemir in patients with type 2 diabetes treated with oral hypoglycemic agents in routine clinical practice
Stuart Ross, Grzegorz Dzida, Qiuhe Ji, Marcel Kaiser, Robert Ligthelm, Luigi Meneghini, Avideh Nazeri, Domingo Orozco-Beltran, Changyu Pan, Anne Louise Svendsen, SOLVE Study Group, Jean-François Yale, Stuart Ross, Qiuhe Ji, Chang Yu Pan, Marcel Kaiser, Andreas Liebl, Eddy Karnieli, Salvatore Caputo, Alberto Maran, Robert Ligthelm, Grzegorz Dzida, Luisa Raimundo, Sara Artola, Domingo Orozco-Beltran, Taner Damci, Sazi Imamoglu, Jiten Vora, Kamlesh Khunti, Luigi Meneghini, Stuart Ross, Grzegorz Dzida, Qiuhe Ji, Marcel Kaiser, Robert Ligthelm, Luigi Meneghini, Avideh Nazeri, Domingo Orozco-Beltran, Changyu Pan, Anne Louise Svendsen, SOLVE Study Group, Jean-François Yale, Stuart Ross, Qiuhe Ji, Chang Yu Pan, Marcel Kaiser, Andreas Liebl, Eddy Karnieli, Salvatore Caputo, Alberto Maran, Robert Ligthelm, Grzegorz Dzida, Luisa Raimundo, Sara Artola, Domingo Orozco-Beltran, Taner Damci, Sazi Imamoglu, Jiten Vora, Kamlesh Khunti, Luigi Meneghini
Abstract
Background: The aim of the present study was to identify demographic and treatment factors that were predictive of hypoglycemia in a large cohort of type 2 diabetic patients initiating insulin detemir.
Methods: The present 24-week observational study of insulin initiation included 17 374 participants from 10 countries. Severe hypoglycemia was defined as an event requiring third party assistance; minor hypoglycemia was defined as a daytime or nocturnal glucose measurement <3.1 mmol/L.
Results: Prior to initiating insulin therapy, 4.9% of the cohort reported hypoglycemia (pre-insulin hypoglycemia), with most (94.2%) reporting minor events and 9.6% reporting severe events. Compared with patients without pre-insulin hypoglycemia, those with pre-insulin hypoglycemia had a higher incidence of events of minor hypoglycemia (1.72 vs 4.46 events per patient-year [ppy], respectively), nocturnal hypoglycemia (0.25 vs 1.09 events ppy, respectively), and severe hypoglycemia (<0.01 vs 0.04 events ppy, respectively) at final visit. Age (P < 0.047), body mass index (P < 0.001), a prior history of microvascular disease (P < 0.001), pre-insulin hypoglycemia (P < 0.001), increased number of oral hypoglycemic agents (OHAs; P < 0.001), OHA intensification (P < 0.001), and the use of glinides (P = 0.004) were all found to be independently associated with the occurrence of hypoglycemia during the study.
Conclusions: Once-daily insulin detemir therapy was safe and effective, and rates of hypoglycemia were low. Concerns about hypoglycemia should not deter the initiation of basal insulin analogs.
Keywords: ambulatory care; basal insulin; oral hypoglycemic agent; sulfonylurea; type 2 diabetes mellitus; 非卧床护理，基础胰岛素，口服降糖药，磺脲，2型糖尿病.
© 2013 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.
Source: PubMed