School of Graduate Entry Medicine, University of Nottingham, Derby, UK.
Diabet Med. 2013 Mar;30(3):e95-100. doi: 10.1111/dme.12096.
To describe baseline characteristics of responders to insulin therapy (HbA(1c) targets < 58 mmol/mol, 7.5%) at 18 months among adults with newly diagnosed diabetes.
A retrospective UK study derived from 479 general practices electronic dataset. We included all adults (age > 18 years) with newly diagnosed diabetes who required insulin therapy within 6 months of diagnosis. The data comprised insulin regimen (long-acting only; premixed insulin only; basal bolus insulin regimen), gender, Townsend quintile, baseline and an 18-month measurement of clinical and biochemical variables. Multiple imputations were undertaken and logistic regression used to assess the effect of covariates.
A total of 1492 patients (aged 19-93 years) were analysed. Means (SD) baseline HbA(1c) and BMI were 10.3% (2.6%) and 29.6 (7.0%), respectively. Following multiple imputation for missing data, logistic regression analysis indicated important covariates to achieve HbA(1c) targets were baseline HbA(1c), lipid lowering therapy, gender and age. Including all covariates, those treated with premixed insulin were 47% more likely to achieve target HbA(1c) at 18 months than those treated with a basal-bolus regimes (adjusted OR 1.47; 95% CI 1.12-1.92, P = 0.006)) and 32% more likely than those treated with long-acting insulin was (adjusted OR 1.32; 95% CI 1.01-1.74, P = 0.044). Those with a higher baseline HbA(1c) level, on lipid-lowering therapy, women and younger patients had a lower response rate. Mean weight gain (SD) was 2.4 kg (8.5 kg) and was not influenced by treatment regimen.
The use of premixed insulin regimen among newly diagnosed patients with diabetes appears to be most effective in reaching HbA(1c) target values, independent of other confounders. The appropriate choice of insulin regimen at initiation should therefore take into account various metabolic and psychosocial factors.
描述新诊断糖尿病患者接受胰岛素治疗 18 个月后（HbA1c 目标＜58mmol/mol，7.5%）应答者的基线特征。
这是一项来自英国 479 家普通诊所电子数据库的回顾性研究。我们纳入了所有在诊断后 6 个月内需要胰岛素治疗的新诊断糖尿病成人（年龄＞18 岁）。数据包括胰岛素方案（仅长效；仅预混胰岛素；基础-餐时胰岛素方案）、性别、汤森德五分位数、基线和 18 个月的临床和生化变量测量值。采用多重插补法进行缺失数据的处理，并使用逻辑回归评估协变量的影响。
共分析了 1492 例患者（年龄 19-93 岁）。HbA1c 和 BMI 的平均值（标准差）分别为 10.3%（2.6%）和 29.6（7.0%）。在对缺失数据进行多重插补后，逻辑回归分析表明，实现 HbA1c 目标的重要协变量是基线 HbA1c、降脂治疗、性别和年龄。将所有协变量纳入后，与接受基础-餐时胰岛素治疗的患者相比，接受预混胰岛素治疗的患者在 18 个月时达到 HbA1c 目标的可能性高 47%（校正比值比 1.47；95%置信区间 1.12-1.92，P=0.006），而与接受长效胰岛素治疗的患者相比，达到目标的可能性高 32%（校正比值比 1.32；95%置信区间 1.01-1.74，P=0.044）。基线 HbA1c 水平较高、正在接受降脂治疗、女性和年轻患者的应答率较低。平均体重增加（标准差）为 2.4kg（8.5kg），与治疗方案无关。
在新诊断的糖尿病患者中，使用预混胰岛素方案似乎是达到 HbA1c 目标值最有效的方法，独立于其他混杂因素。因此，在开始时选择合适的胰岛素方案时，应考虑各种代谢和心理社会因素。
