Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes

Sun Ok Song, You-Cheol Hwang, Kyu-Jeung Ahn, Bong Soo Cha, Young Duk Song, Dae Wook Lee, Byung-Wan Lee, Sun Ok Song, You-Cheol Hwang, Kyu-Jeung Ahn, Bong Soo Cha, Young Duk Song, Dae Wook Lee, Byung-Wan Lee

Abstract

Introduction: A1chieve® (ClinicalTrials.gov identifier NCT00869908) was a 24-week observational study evaluating certain insulin analogs and not insulin analogs in general in 66,726 people with type 2 diabetes (T2D) in routine clinical care in 28 non-Western countries. This study demonstrated that insulin analogs improved self-management and metabolic control in patients with T2D. We investigated the effectiveness and clinical characteristics of patients with T2D showing better response to basal insulin (BI) (detemir), using data from the A1chieve study performed in Korea.

Methods: Subjects were classified into two groups according to the achievement of target glycated hemoglobin (A1c) level of <7.5%. Multivariate logistic regression analysis was performed to determine the variables independently associated with the achievement of target A1c level.

Results: Baseline A1c, postprandial glucose (PPG), difference between PPG and fasting plasma glucose, and duration of diabetes were independently associated with better response to BI after adjusting for other risk factors. Compared to patients with BI use at evening, those who took BI in the morning demonstrated a larger reduction in A1c level.

Conclusion: Once-daily BI therapy appears to be effective in Korean subjects with type 2 diabetes who had a shorter duration of diabetes and a smaller postprandial glucose excursion.

Funding: Novo Nordisk Pharma Korea and Novo Nordisk International Operations.

Keywords: A1chieve® study; Basal insulin responder; Detemir; Korea.

Figures

Fig. 1
Fig. 1
Flowchart illustrating the number of patients included in the A1chieve® sub-study in Korea. HbA1c glycated hemoglobin

References

    1. Shah SN, Litwak L, Haddad J, Chakkarwar PN, Hajjaji I. The A 1 chieve 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:S11–S16. doi: 10.1016/S0168-8227(10)70003-6.
    1. Home P, El Naggar N, Khamseh M, Gonzalez-Galvez G, Shen C, Chakkarwar P, et al. An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A 1 chieve study. Diabetes Res Clin Pract. 2011;94(3):352–363. doi: 10.1016/j.diabres.2011.10.021.
    1. Yoo HJ, Park KY, Park KS, Ahn KJ, Min KW, Park JH, et al. Safety and efficacy of modern insulin analogues. Diabetes Metab J. 2013;37(3):181–189. doi: 10.4093/dmj.2013.37.3.181.
    1. Lee YH, Lee BW, Chun S, Cha B, Lee H. Predictive characteristics of patients achieving glycaemic control with insulin after sulfonylurea failure. Int J Clin Pract. 2011;65(10):1076–1084. doi: 10.1111/j.1742-1241.2011.02755.x.
    1. Jung CH, Park JY, Cho JH, Yoon KH, Yang HK, Lee YH, et al. The optimal morning:evening ratio in total dose of twice-daily biphasic insulin analogue in poorly controlled Type 2 diabetes: a 24-week multi-centre prospective, randomized controlled, open-labelled clinical study. Diabet Med. 2014;31(1):68–75. doi: 10.1111/dme.12322.
    1. Lee Y-H, Lee B-W, 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(6):508–514. doi: 10.1089/dia.2011.0208.
    1. Hwang YC, Kang JG, Ahn KJ, Cha BS, Ihm SH, Lee S, et al. 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((R)) study. Int J Clin Pract. 2014;68(11):1338–1344. doi: 10.1111/ijcp.12482.
    1. Karnieli E, Baeres FM, Dzida G, Ji Q, Ligthelm R, Ross S, et al. Observational study of once-daily insulin detemir in people with Type 2 diabetes aged 75 years or older. Drugs Aging. 2013;30(3):167–175. doi: 10.1007/s40266-013-0054-3.
    1. Raskin P, Allen E, Hollander P, Lewin A, Gabbay RA, Hu P, et al. Initiating insulin therapy in type 2 diabetes A comparison of biphasic and basal insulin analogs. Diabetes Care. 2005;28(2):260–265. doi: 10.2337/diacare.28.2.260.
    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 subjects with poorly controlled type 2 diabetes mellitus. Diabetes Metab J. 2012;36(3):230–236. doi: 10.4093/dmj.2012.36.3.230.
    1. Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Factors associated with psychological insulin resistance in individuals with type 2 diabetes. Diabetes Care. 2010;33(8):1747–1749. doi: 10.2337/dc10-0099.
    1. Mollema E, Snoek F, Heine R, Van der Ploeg H. Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening. Diabet Med. 2001;18(8):671–674. doi: 10.1046/j.1464-5491.2001.00547.x.
    1. Kalra S, Gupta Y. Basal insulin inadequacy versus failure—using appropriate terminology. Eur Endocrinol. 2015;11(2):79–80. doi: 10.17925/EE.2015.11.02.79.
    1. Home PD, Shen C, Hasan MI, Latif ZA, Chen J-W, Gálvez GG. Predictive and explanatory factors of change in HbA1c in a 24-week observational study of 66,726 people with type 2 diabetes starting insulin analogs. Diabetes Care. 2014;37(5):1237–1245. doi: 10.2337/dc13-2413.
    1. Kalra S, Gupta Y. Insulin initiation: bringing objectivity to choice. J Diabetes Metab Disord. 2015;14(1):17. doi: 10.1186/s40200-015-0146-1.
    1. Lasserson D, Glasziou P, Perera R, Holman R, Farmer A. Optimal insulin regimens in type 2 diabetes mellitus: systematic review and meta-analyses. Diabetologia. 2009;52(10):1990–2000. doi: 10.1007/s00125-009-1468-7.
    1. Yale J-F, Damci T, Kaiser M, Karnieli E, Khunti K, Liebl A, et al. Initiation of once daily insulin detemir is not associated with weight gain in patients with type 2 diabetes mellitus: results from an observational study. Diabetol Metab Syndr. 2013;5(1):56. doi: 10.1186/1758-5996-5-56.
    1. Herbst KL, Hirsch IB. Insulin strategies for primary care providers. Clin Diabetes. 2002;20(1):11–17. doi: 10.2337/diaclin.20.1.11.
    1. Hirsch IB. Insulin analogues. N Engl J Med. 2005;352(2):174–183. doi: 10.1056/NEJMra040832.
    1. Devries J, Nattrass M, Pieber T. Refining basal insulin therapy: what have we learned in the age of analogues? Diabetes Metab Res Rev. 2007;23(6):441–454. doi: 10.1002/dmrr.762.
    1. Philis-Tsimikas A, Charpentier G, Clauson P, Ravn GM, Roberts VL, Thorsteinsson B. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin Ther. 2006;28(10):1569–1581. doi: 10.1016/j.clinthera.2006.10.020.
    1. Yang W, Zilov A, Soewondo P, Bech OM, Sekkal F, Home PD. Observational studies: going beyond the boundaries of randomized controlled trials. Diabetes Res Clin Pract. 2010;88:S3–S9. doi: 10.1016/S0168-8227(10)70002-4.

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