The glycemic efficacies of insulin analogue regimens according to baseline glycemic status in Korean patients with type 2 diabetes: sub-analysis from the A(1)chieve(®) study

Y-C Hwang, J G Kang, K J Ahn, B S Cha, S-H Ihm, S Lee, M Kim, B-W Lee, Y-C Hwang, J G Kang, K J Ahn, B S Cha, S-H Ihm, S Lee, M Kim, B-W Lee

Abstract

Aims: In this study, we compared the glucose-lowering effectiveness of insulin analogues and their combination according to baseline glycemic status in patients with type 2 diabetes (T2D) from the A1 chieve(®) study conducted in Korea.

Methods: This sub-analysis from the A1 chieve(®) study was a 24-week prospective, multicenter, non-interventional, open-labelled study. Of the 4058 patients, 3074 patients who had their HbA1c level measured at baseline were included in this sub-analysis. We classified patients into three groups according to baseline HbA1c levels: group I (HbA1c < 7.5%), group II (7.5% ≤ HbA1c < 9.0%) and group III (HbA1c ≥ 9.0%).

Results: Patients in group I showed no significant HbA1c reduction with any insulin regimens (detemir, aspart, detemir and aspart or biphasic aspart 30 (Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark) after 24 weeks of treatment. In group II, although HbA1c was decreased for all insulin regimens, there was no difference in mean HbA1c reduction among the four insulin regimens. In patients with a high baseline HbA1c level (group III), mean HbA1c reduction was the greatest in patients on a basal-bolus regimen (detemir and aspart, -3.50%) and lowest in patients on a bolus regimen (aspart, -1.81%; p < 0.001).

Conclusion: For optimal glycaemic control, a basal-bolus regimen may be adequate for Korean patients with poorly controlled T2D (HbA1c ≥ 9.0%).

© 2014 John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flow diagram of study

References

    1. Home P, Naggar NE, Khamseh M, et al. An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract. 2011;94:352–63.
    1. Yoo HJPK, Park KS, Ahn KJ, et al. Safety and efficacy of modern insulin products. Diabetes Metab J. 2013;37:181–9.
    1. Lee YH, Lee BW, Chun SW, Cha BS, Lee HC. Predictive characteristics of patients achieving glycaemic control with insulin after sulfonylurea failure. Int J Clin Pract. 2011;65:1076–84.
    1. Lee YH, Lee BW, Kwon HJ, Kang ES, Cha BS, Lee HC. Higher morning to evening ratio in total dose of twice-daily biphasic insulin analog might be effective in achieving glucose control in patients with poorly controlled type 2 diabetes. Diabetes Technol Ther. 2012;14:508–14.
    1. Choe EY, Lee YH, Lee BW, Kang ES, Cha BS, Lee HC. Glycemic effects of once-a-day rapid-acting insulin analogue addition on a basal insulin analogue in Korean patients with poorly controlled type 2 diabetes mellitus. Diabetes Metab J. 2012;36:230–6.
    1. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2012;35:1364–79.
    1. Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009;15:540–59.
    1. Ko SH, Kim SR, Kim DJ, et al. 2011 clinical practice guidelines for type 2 diabetes in Korea. Diabetes Metab J. 2011;35:431–6.
    1. Tibaldi J, Rakel RE. Why, when and how to initiate insulin therapy in patients with type 2 diabetes. Int J Clin Pract. 2007;61:633–44.
    1. Shah SN, Litwak L, Haddad J, Chakkarwar PN, Hajjaji I. The A1chieve study: a 60 000-person, global, prospective, observational study of basal, meal-time, and biphasic insulin analogs in daily clinical practice. Diabetes Res Clin Pract. 2010;88(Suppl. 1):S11–6.
    1. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193–203.
    1. Rhee SY, Woo JT. The prediabetic period: review of clinical aspects. Diabetes Metab J. 2011;35:107–16.
    1. Groop LC, Pelkonen R, Koskimies S, Bottazzo GF, Doniach D. Secondary failure to treatment with oral antidiabetic agents in non-insulin-dependent diabetes. Diabetes Care. 1986;9:129–33.
    1. Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet. 2011;378:169–81.
    1. Lee BW, Kang HW, Heo JS, et al. Insulin secretory defect plays a major role in the development of diabetes in patients with distal pancreatectomy. Metabolism. 2006;55:135–41.
    1. Kim DJ, Lee MS, Kim KW, Lee MK. Insulin secretory dysfunction and insulin resistance in the pathogenesis of korean type 2 diabetes mellitus. Metabolism. 2001;50:590–3.

Source: PubMed

3
S'abonner