TY - JOUR
T1 - Predictors and clinical outcomes of treatment intensification in patients with type 2 diabetes uncontrolled on basal insulin in a real-world setting
AU - Kallenbach, Lee
AU - Shui, Amy M.
AU - Cheng, Wendy Y.
AU - Fan, Tao
AU - Hu, Wenli
AU - Zichlin, Miriam L.
AU - Duh, Mei Sheng
AU - Ye, Fen
AU - Levin, Philip A.
N1 - Funding Information:
The authors received writing/editorial support in the preparation of this manuscript provided by Yunyu Huang, PhD, of Excerpta Medica, funded by Sanofi.
Funding Information:
This study was funded by Sanofi. L.K. is an employee of Practice Fusion, under contract with Sanofi. A.S. is a consultant for Practice Fusion and was an employee of Practice Fusion at the time the study was conducted, under contract with Sanofi. W.C., M.Z., and M.D. are employees of Analysis Group, Inc, under contract with Sanofi. T.F. was an employee of Sanofi at the time the study was conducted. W.H. and F.Y. are employees of Sanofi. P.L. is a consultant for Novo Nordisk, Inc, and Sanofi; member of the advisory panel for Novo Nordisk, Inc, and Sanofi; received research support from Amylin Pharmaceuticals, Inc, Eli Lilly and Company, Merck & Co, Novo Nordisk, Inc, Roche, and Sanofi; member of the speakers bureau and author for Amylin Pharmaceuticals, Inc, AstraZeneca, BMS, Boehringer Ingelheim, Eli Lilly and Company, Janssen Pharmaceuticals, Inc, Novo Nordisk, Inc, and Sanofi.
Publisher Copyright:
© 2018 AACE.
PY - 2018/9
Y1 - 2018/9
N2 - Objective: To understand factors associated with intensification of basal insulin therapy and treatment impact on clinical outcomes in patients with type 2 diabetes (T2D). Methods: In this retrospective, observational study of the Practice Fusion electronic health record database, eligible patients were adults with T2D, ≥1 basal insulin prescription and office visit in the 6 months before a glycated hemoglobin A1c (A1C) test >7.0% (index date), and no other injectable prescriptions in the 12 months before the index date. Patients were categorized to intensifiers with injectables (rapid-acting insulin [RAI], glucagon-like peptide-1 receptor agonist [GLP-1 RA], or other injectables) or nonintensifiers with injectables (including no change, adding an oral antidiabetes drug, or changing basal insulin dose). Principal outcomes were A1C change, hypoglycemia incidence, and change in body weight. Results: Among 14,653 patients, 2,121 (14.5%) and 12,532 (85.5%) were categorized as intensifiers and nonintensifiers with injectables, respectively. Compared with nonintensifiers, intensifiers were more likely to have an endocrinologist as the prescribing physician (odds ratio [OR], 2.52 [95% confidence interval (CI), 2.16 to 2.94]), hypertension (OR, 1.26 [95% CI, 1.08 to 1.47]), higher baseline A1C (OR, 1.22 [95% CI, 1.17 to 1.26]), obesity (OR, 1.17 [95% CI, 1.01 to 1.36]), and higher body mass index (OR, 1.02 [95% CI, 1.01 to 1.03]). In GLP-1 RA intensifiers, the baseline use of dipeptidyl peptidase-4 inhibitors increased the likelihood of intensification. GLP-1 RA intensifiers had equivalent glycemic control to RAI or other injectables, with a nonsignificantly lower risk of hypoglycemia and reduction in body weight. Conclusion: Addition of GLP-1 RA to basal insulin may be an effective strategy for overcoming clinical inertia with injectable therapy in patients with T2D. (Endocr Pract. 2018;24:805-814)
AB - Objective: To understand factors associated with intensification of basal insulin therapy and treatment impact on clinical outcomes in patients with type 2 diabetes (T2D). Methods: In this retrospective, observational study of the Practice Fusion electronic health record database, eligible patients were adults with T2D, ≥1 basal insulin prescription and office visit in the 6 months before a glycated hemoglobin A1c (A1C) test >7.0% (index date), and no other injectable prescriptions in the 12 months before the index date. Patients were categorized to intensifiers with injectables (rapid-acting insulin [RAI], glucagon-like peptide-1 receptor agonist [GLP-1 RA], or other injectables) or nonintensifiers with injectables (including no change, adding an oral antidiabetes drug, or changing basal insulin dose). Principal outcomes were A1C change, hypoglycemia incidence, and change in body weight. Results: Among 14,653 patients, 2,121 (14.5%) and 12,532 (85.5%) were categorized as intensifiers and nonintensifiers with injectables, respectively. Compared with nonintensifiers, intensifiers were more likely to have an endocrinologist as the prescribing physician (odds ratio [OR], 2.52 [95% confidence interval (CI), 2.16 to 2.94]), hypertension (OR, 1.26 [95% CI, 1.08 to 1.47]), higher baseline A1C (OR, 1.22 [95% CI, 1.17 to 1.26]), obesity (OR, 1.17 [95% CI, 1.01 to 1.36]), and higher body mass index (OR, 1.02 [95% CI, 1.01 to 1.03]). In GLP-1 RA intensifiers, the baseline use of dipeptidyl peptidase-4 inhibitors increased the likelihood of intensification. GLP-1 RA intensifiers had equivalent glycemic control to RAI or other injectables, with a nonsignificantly lower risk of hypoglycemia and reduction in body weight. Conclusion: Addition of GLP-1 RA to basal insulin may be an effective strategy for overcoming clinical inertia with injectable therapy in patients with T2D. (Endocr Pract. 2018;24:805-814)
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U2 - 10.4158/EP-2017-0261
DO - 10.4158/EP-2017-0261
M3 - Article
C2 - 29975575
AN - SCOPUS:85054758068
SN - 1530-891X
VL - 24
SP - 805
EP - 814
JO - Endocrine Practice
JF - Endocrine Practice
IS - 9
ER -