Vol. 6 (02) pp. 348-361 DOI: 10.21474/IJAR01/6445

GLYCEMIC CONTROL IN PEOPLE WITH TYPE 2 DIABETES COMMENCING OR ADJUSTING INSULIN TREATMENT IN CLINICAL PRACTICE: A MULTINATIONAL, MULTICENTER, OBSERVATIONAL COHORT STUDY IN THE GULF REGION.

, and
  • Spital, United Arab Emirates.
  • RCDR-Khalifa Hospital, United Arab Emirates.
12 Downloads 114 Views
Crossref

Download Full Paper (PDF)

Abstract

Type 2 diabetes mellitus (T2DM) is prevalent in the Middle East and North Africa as a consequence of increasing aging populations, rapid urbanization, lack of physical exercise, and obesity. Our study objective is to explore glycemic outcomes in people with T2DM patients who initiated basal insulin treatment or who received a further adjustment of existing insulin treatment. Multinational, multicenter, non-interventional study was conducted in the Gulf region. The primary objective was to assess HbA1c reduction from baseline, to three and six months following treatment with insulin-based regimens. Secondary outcomes included the percentage of patients achieving the HbA1c target of <7.0% at 6 months, change in fasting, and postprandial blood glucose, insulin dose, body weight, the incidence of hypoglycemia, and patient characteristics associated with the success of glycemic control. Overall, 1196 patients from 102 centers were recruited and 1083 received a basal insulin-based therapy for six-months. Mean (SD) baseline characteristics were: age 56.2 ? 12 years, weight 82.7 ? 14.9 kg, BMI 29.8 ? 5.2 kg/m?, diabetes duration 11 ? 6.9 years, and 55% were male. Initiation or adjustment of basal insulin reduced mean HbA1c from 9.8% ? 1.6% to 7.6% ? 1% and mean FBG from 208.1 ? 70 mg/dl to 128.6 ? 32.3 mg/dl. At 6 months, 25.9% of patients achieved target HbA1c <7.0%. Predictors of glycemic control (HbA1c <7%) included age (OR = 1.01; p = 0.043), baseline HbA1c (OR = 0.68; p < 0.001), BMI (OR = 0.96; p = 0.012), and exercise (OR = 1.5; p = 0.036). Incidence of hypoglycemia was 5.3%, and no significant change in body weight was observed (p = 0.074). In conclusion, Basal insulin treatment with or without addition of prandial insulin is an efficacious and well tolerated regimen for T2DM patients from the Gulf regions inadequately controlled with oral antidiabetic drugs.

Keywords

Article Analytics

References

  1. Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990?2013: quantifying the epidemiological transition. The Lancet. 2015 Dec 4;386(10009):2145-91.
  2. World Health Organization. Global report on diabetes. World Health Organization; 2016.
  3. Wild S, Roglic G, Green A, et al. Global prevalence for diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27(5):1047-53.
  4. Majeed A, El-Sayed AA, Khoja T, Alshamsan R, Millett C, Rawaf S. Diabetes in the Middle-East and North Africa: an update. Diabetes research and clinical practice. 2014 Feb 28;103(2):218-22.
  5. Zabetian A, Keli HM, Echouffo-Tcheugui JB, Narayan KV, Ali MK. Diabetes in the middle east and north Africa. Diabetes research and clinical practice. 2013 Aug 31;101(2):106-22.
  6. DeFronzo RA. Pathogenesis of type 2 diabetes: Metabolic and molecular implications for identifying diabetes genes. Diabetes Res Clin Pract. 1997;5:177?269.
  7. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Bmj. 2000 Aug 12;321(7258):405-12.
  8. American Diabetes Association. Standards of medical care in diabetes ? 2017. Diabetes Care. 2017; 40 (Suppl. 1): 1?142.
  9. Hamaty M. Insulin treatment for type 2 diabetes: When to start, which to use. Cleve Clin J Med. 2011;78(5):332-342.
  10. Pearson J, Powers MA. Systematically initiating insulin: the staged diabetes management approach. Diabetes Educ. 2006;32(1):19S?28S.
  11. Sharplin P, Gordon J, Peters JR, Tetlow AP, Longman AJ, McEwan P. Switching from premixed insulin to glargine-based insulin regimen improves glycaemic control in patients with type 1 or type 2 diabetes: a retrospective primary care-based analysis. Cardiovascular diabetology. 2009 Feb 16;8(1):9.
  12. Le Floch JP. Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics. Diabetes, metabolic syndrome and obesity: targets and therapy. 2010;3:197.
  13. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, Howard BV, Kirkman MS, Kosiborod M, Reaven P, Sherwin RS. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials. Circulation. 2009 Jan 20;119(2):351-7.
  14. Sorli C, Heile MK. Identifying and meeting the challenges of insulin therapy in type 2 diabetes. Journal of multidisciplinary healthcare. 2014;7:267.
  15. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Physical therapy. 2008 Nov 1;88(11):1254-64.
  16. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. Prevalence of lower-extremity disease in the US adult population≥ 40 years of age with and without diabetes. Diabetes care. 2004 Jul 1;27(7):1591-7.
  17. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle Prospective Diabetic Foot Study. Diabetes care. 1997 Jul 1;20(7):1162-7.
  18. Pagano E, Brunetti M, Tediosi F, Garattini L. Costs of Diabetes. Pharmacoeconomics. 1999 Jun 1;15(6):583-95.
  19. Clarke P, Gray A, Legood R, Briggs A, Holman R. The impact of diabetes‐related complications on healthcare costs: results from the United Kingdom Prospective Diabetes Study (UKPDS Study No. 65). Diabetic Medicine. 2003 Jun 1;20(6):442-50.
  20. Schreiber SA, Haak T. Insulin glargine benefits patients with type 2 diabetes inadequately controlled on oral antidiabetic treatment: an observational study of everyday practice in 12,216 patients. Diabetes, Obesity and Metabolism. 2007 Jan 1;9(1):31-8.
  21. Riddle MC, Rosenstock J, Gerich J. The treat-to-target trial. Diabetes care. 2003 Nov 1;26(11):3080-6.
  22. Rosenstock J, Schwartz SL, Clark CM, Park GD, Donley DW, Edwards MB. Basal insulin therapy in type 2 diabetes. Diabetes care. 2001 Apr 1;24(4):631-6.
  23. Fritsche A, Schweitzer MA, Hring HU. Glimepiride Combined with Morning Insulin Glargine, Bedtime Neutral Protamine Hagedorn Insulin, or Bedtime Insulin Glargine in Patients with Type 2 DiabetesA Randomized, Controlled Trial. Annals of internal medicine. 2003 Jun 17;138(12):952-9.
  24. Yki‐J?rvinen H. Combination therapy with insulin and oral agents: optimizing glycemic control in patients with type 2 diabetes mellitus. Diabetes/metabolism research and reviews. 2002 Sep 1;18(S3).
  25. Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L, Hoskin M, Kriska AM, Mayer-Davis EJ, Pi-Sunyer X, Regensteiner J. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes care. 2006 Sep 1;29(9):2102-7.
  26. Korytkowski M. When oral agents fail: practical barriers to starting insulin. International Journal of Obesity. 2002 Sep 1;26(S3):S18.
  27. Johnson R, Haubner B, Bolinder B. Trade-offs between glucose control and hypoglycemia in different patient types: results of a 5-country physician survey. Diabetes. 2003 Jun 1;52:A264.
  28. Janka HU, Plewe G, Riddle MC, Kliebe-Frisch C, Schweitzer MA, Yki-J?rvinen H. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes. Diabetes care. 2005 Feb 1;28(2):254-9.
  29. Gale EAM, Beattie SD, HU J, et al. Recruitment to a clinical trial improves glycemic control in patients with diabetes. Diabetes Care. 2007;30(12):2989-92.
  30. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient preference and adherence. 2016;10:1299.
  31. Ali MK, Bullard KM, Imperatore G, Barker L, Gregg EW. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes?National Health and Nutrition Examination Survey, United States, 2007?2010. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61(2):32-7.
  32. Ford ES. Trends in the control of risk factors for cardiovascular disease among adults with diagnosed diabetes: findings from the National Health and Nutrition Examination Survey 1999?2008. Journal of diabetes. 2011 Dec 1;3(4):337-47.
  33. Egede LE, Gebregziabher M, Echols C, Lynch CP. Longitudinal effects of medication nonadherence on glycemic control. Annals of Pharmacotherapy. 2014 a May;48(5):562-70.
  34. Egede LE, Gebregziabher M, Dismuke CE, Lynch CP, Axon RN, Zhao Y, Mauldin PD. Medication nonadherence in diabetes. Diabetes care. 2012b Dec 1;35(12):2533-9.
  35. DiBonaventura M, Wintfeld N, Huang J, Goren A. The association between nonadherence and glycated hemoglobin among type 2 diabetes patients using basal insulin analogs. Patient preference and adherence. 2014;8:873.
  36. Sapkota S, Jo-anne EB, Greenfield JR, Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes?components of interventions. PLoS One. 2015 Jun 8;10(6):e0128581.

How to Cite This Article

Rashid Ho Khadija, Ahmed Hafidh and Salah Abusnana. (2018); GLYCEMIC CONTROL IN PEOPLE WITH TYPE 2 DIABETES COMMENCING OR ADJUSTING INSULIN TREATMENT IN CLINICAL PRACTICE: A MULTINATIONAL, MULTICENTER, OBSERVATIONAL COHORT STUDY IN THE GULF REGION., Int. J. of Adv. Res., 6 (02), 348-361, ISSN 2320-5407. DOI: https://doi.org/10.21474/IJAR01/6445

Corresponding Author

Khadija Ahmed Hafidh
Rashid Hospital, United Arab Emirates
Creative Commons Attribution 4.0 This work is licensed under a Creative Commons Attribution 4.0 International License.