Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System.
- Resource Type
- Academic Journal
- Authors
- Mast MR; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands.; Walraven I; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.; Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands.; Hoekstra T; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.; Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.; Jansen AP; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.; van der Heijden AA; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.; Elders PJ; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.; Heine RJ; Eli Lilly and Company, Indianapolis, IN, USA.; Dekker JM; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.; Nijpels G; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.; Hugtenburg JG; EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.; Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands.
- Source
- Publisher: Blackwell Science Country of Publication: England NLM ID: 8500858 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-5491 (Electronic) Linking ISSN: 07423071 NLM ISO Abbreviation: Diabet Med Subsets: MEDLINE
- Subject
- Language
- English
Aims: To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy.
Methods: The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion criteria were: age ≥ 40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤ 53 mmol/mol (7%) with oral glucose-lowering agents; and a follow up ≥ 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA1c . Subjects considered to be 'off target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during one-third or more of the follow-up time, and those considered to be 'on target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during less than one-third of the follow-up time.
Results: Four HbA1c trajectories were identified. Most people (88.7%) were classified as having a stable HbA1c trajectory of ~57 mmol/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA1c levels and a higher age at the start of insulin treatment.
Conclusions: Using latent class growth modelling, four HbA1c trajectories were identified. A quarter of the people starting insulin were on target. Low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.
(© 2016 Diabetes UK.)