Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

D Orozco-Beltran, C Pan, A L Svendsen, L Faerch, S Caputo, SOLVE Study Group, D Orozco-Beltran, C Pan, A L Svendsen, L Faerch, S Caputo, SOLVE Study Group

Abstract

Objective: To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters.

Research design and methods: Study of Once-Daily Levemir (SOLVE(™) ) is an international, 24-week, observational study of insulin initiation in people with type 2 diabetes.

Results: A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) -1.2 ± 1.4% (-13.1 ± 15.3 mmol/mol) and -1.3 ± 1.6% (-14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [-0.04%, 95% confidence interval (CI) -0.09 to -0.01 (-0.4 mmol/mol, 95% CI -1.0-0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06-0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64-0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001).

Conclusions: Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.

Trial registration: ClinicalTrials.gov NCT00740519 NCT00825643.

© 2016 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

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Source: PubMed

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