Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
Diabetes Care. 2012 Mar;35(3):495-7. doi: 10.2337/dc11-1171. Epub 2012 Jan 25.
To identify the characteristics associated with glycemic response to newly initiated insulin therapy.
We identified 1,139 type 2 diabetic patients who initiated insulin therapy between 1 January 2009 and 30 June 2010. Outcomes of interest were the proportion of patients achieving A1C <7% and mean change in A1C within 3-9 months.
Mean A1C at insulin initiation was 8.2 vs. 9.2% among those who did and did not attain A1C <7% (P < 0.001). Within a mean of 5 months, 464 (40.7%) patients attained A1C <7%. In multivariable analyses controlling for insulin regimen, dose, and oral agent use, preinsulin A1C was responsible for nearly all the explained variance in A1C change. Each one percentage point of preinsulin A1C reduced the probability of attaining <7% by 26% (odds ratio 0.74 [95% CI 0.68-0.80]).
Insulin initiation at lower levels of A1C improves goal attainment and independently increases glycemic response.
确定与新起始胰岛素治疗的血糖反应相关的特征。
我们确定了 1139 例 2009 年 1 月 1 日至 2010 年 6 月 30 日期间起始胰岛素治疗的 2 型糖尿病患者。主要观察指标为达到 A1C＜7%的患者比例和 3-9 个月内 A1C 的平均变化。
起始胰岛素时 A1C 分别为 8.2%和 9.2%，<7%（P＜0.001）。在平均 5 个月内，464 例（40.7%）患者达到 A1C＜7%。在控制胰岛素方案、剂量和口服药物使用的多变量分析中，起始前 A1C 几乎可以解释 A1C 变化的所有差异。起始前 A1C 每增加 1%，达到＜7%的概率降低 26%（比值比 0.74[95%CI 0.68-0.80]）。
起始胰岛素时 A1C 水平较低可提高目标达标率，独立增加血糖反应。
