Effect of baseline glycosylated hemoglobin A1c on glycemic control and diabetes management following initiation of once-daily insulin detemir in real-life clinical practice.

Abstract

OBJECTIVE:

The SOLVE study investigated the initiation of basal insulin in patients with type 2 diabetes on oral antidiabetic (OAD) treatment and outcomes in patients with varying levels of glycemic control at baseline.

METHODS:

This was an observational cohort study conducted in 10 countries using insulin detemir. Data were collected at 3 clinic visits (baseline, 12-week interim, and 24-week final visit).

RESULTS:

A total of 13,526 (77.9%) patients were included in the glycosylated hemoglobin A1c (HbA1c) subset analysis. Patients were grouped according to pre-insulin HbA1c values as follows: HbA1c <7.6% (n = 2,797); HbA1c 7.6-9% (n = 5,366), and HbA1c >9% (n = 5,363). A total of 27 patients experienced serious adverse drug reactions (SADRs) and/or severe hypoglycemia (3, 10, and 11 patients with pre-insulin HbA1c <7.6%, 7.6-9.0%, and >9.0%, respectively). All patient subgroups realized improvements in HbA1c, with the pre-insulin HbA1c >9% subgroup having the largest HbA1c reduction (-2.4% versus -0.9% and -0.2% for HbA1c subgroups 7.6-9% and <7.6%, respectively). In the total cohort (n = 17,374), the incidence of severe hypoglycemia decreased from 4 events per 100 person years to <1 event per 100 person years by final visit; the incidence of minor hypoglycemia increased from 1.6 to 1.8 events per person year.

CONCLUSIONS:

In this study, insulin initiation was delayed until late in disease course, and overall concordance with internationally recognized guidelines was low. The initiation of once-daily insulin detemir was associated with substantial improvements in glycemic control and was not associated with an increase in severe hypoglycemia or weight gain.

• Authors: Salvatore Caputo, Henning Andersen, Marcel Kaiser, Eddy Karnieli, Luigi F Meneghini, Anne Louise Svendsen, SOLVE Study Group
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) 2013 May-Jun Vol. 19 Issue 3 Pg. 462-70 ISSN: 1934-2403 [Electronic] United States
• PMID: 23337147 (Publication Type: Journal Article)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Insulin, Long-Acting
• Insulin Detemir

Topics

• Aged
• Blood Glucose (drug effects, metabolism)
• Drug Administration Schedule
• Female
• Glycated Hemoglobin (metabolism)
• Humans
• Insulin Detemir
• Insulin, Long-Acting (administration & dosage, therapeutic use)
• Male
• Middle Aged