Observational Registry of Basal Insulin Treatment (ORBIT) in patients with type 2 diabetes uncontrolled with oral antihyperglycaemic drugs: Real-life use of basal insulin in China.

Abstract

AIMS:

To examine treatment patterns following basal insulin (BI) introduction in type 2 diabetes mellitus (T2DM) patients under real-world conditions across China.

MATERIALS AND METHODS:

Overall, 18 995 patients inadequately controlled (HbA1c ≥ 53 mmol/mol [7%]) with oral antihyperglycaemic drugs (OADs) and willing to receive BI treatment were registered at 209 hospitals and followed at baseline (visit 1), 3 months (visit 2) and 6 months (visit 3). Type of BI was initiated at physicians' discretion.

RESULTS:

Retention with BI therapy at 6 months was 75.6%. Use of long-acting BI predominated, with insulin glargine accounting for 71%, detemir 13% and Neutral Protamine Hagedorn (NPH) insulin 16%. Over 70% of long-acting users maintained the same initial BI at visit 3, while 40% of NPH users switched treatment and 24.4% of participants initiated BI with prandial insulin. The initial mean (± SD) dose of BI and total insulin was 0.18 ± 0.07 and 0.25 ± 0.19 IU/kg, respectively, with a mean increase of daily dose by 0.03 and 0.02 IU/kg after 6 months, respectively. Only 56.6% of insulin users reported dose titration at visit 3. Mean HbA1c was 81 mmol/mol (9.6%) at baseline and 57 mmol/mol (7.4%) at 6 months. The frequency of hypoglycaemia was 1.61 and 2.07 episodes/patient-year at baseline and 6 months, respectively.

CONCLUSIONS:

In real-world clinical settings, add-on BI therapy in T2DM patients is associated with significant improvement in glycaemic control without overtly compromising safety related to hypoglycaemia and weight gain. Evolution of insulin treatment regimens varied among patients, but dose titration was suboptimal. More active BI dose titration might further improve glycaemic outcome in patients receiving BI therapy.

VIDEO ABSTRACT:

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• Authors: Linong Ji, Puhong Zhang, Dongshan Zhu, Xian Li, Jiachao Ji, Juming Lu, Xiaohui Guo, Weiping Jia, Jianping Weng, Yangfeng Wu, Wenying Yang, Dajin Zou, Zhiguang Zhou, Changyu Pan, Yan Gao, Satish K Garg
• Journal: Diabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 19 Issue 6 Pg. 822-830 (06 2017) ISSN: 1463-1326 [Electronic] England
• PMID: 28105735 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin, Long-Acting
• hemoglobin A1c protein, human

Topics

• Aged
• Blood Glucose (drug effects)
• China
• Diabetes Mellitus, Type 2 (blood, drug therapy)
• Drug Therapy, Combination
• Female
• Glycated Hemoglobin (drug effects)
• Humans
• Hypoglycemia (chemically induced)
• Hypoglycemic Agents (administration & dosage)
• Insulin, Long-Acting (administration & dosage)
• Male
• Middle Aged
• Registries
• Treatment Outcome