Khunti Kamlesh, Vora Jiten, Davies Melanie
University of Leicester, Leicester, UK.
Royal Liverpool University Hospital, Liverpool, UK.
Prim Care Diabetes. 2014 Apr;8(1):57-63. doi: 10.1016/j.pcd.2013.11.010. Epub 2013 Dec 27.
SOLVE was a large observational study of more than 17,000 insulin-naïve patients with type 2 diabetes, investigating basal insulin analogue initiation in a primary care setting across a diverse geographical area. The current analysis aimed to compare and contrast the results of the UK cohort with the previously published global population results.
This analysis compares the UK cohort of SOLVE (n=761) with the global population (n=17,374). Patients eligible for the study were those for whom a clinical decision had been made to initiate treatment with a basal insulin analogue once daily as an add-on to existing OAD therapy.
The UK cohort had a higher baseline HbA1c compared to the global population of SOLVE (9.8% vs. 8.9%, respectively) despite a shorter duration of disease, indicating that strict glycaemic targets set by international organisations are not being achieved in the UK. Following 24 weeks' treatment with insulin detemir, patients in the UK achieved a reduction in HbA1c of -1.3%, the same as the reduction achieved in the global population; however, a higher dose of insulin detemir was required in the UK than in the global population.
Findings from the UK cohort of SOLVE show that it is possible to improve glycaemic control and reduce HbA1c in patients previously uncontrolled with oral antidiabetic drug therapy, in a primary setting, despite clinical inertia.
SOLVE是一项针对超过17000例未使用过胰岛素的2型糖尿病患者的大型观察性研究,调查在不同地理区域的基层医疗环境中起始基础胰岛素类似物治疗的情况。当前分析旨在比较和对比英国队列与先前发表的全球人群结果。
本分析将SOLVE研究中的英国队列(n = 761)与全球人群(n = 17374)进行比较。符合研究条件的患者是那些已做出临床决策,将每日一次基础胰岛素类似物作为现有口服抗糖尿病药物治疗的附加治疗开始使用的患者。
尽管病程较短,但英国队列的基线糖化血红蛋白(HbA1c)高于SOLVE研究的全球人群(分别为9.8%和8.9%),这表明英国未实现国际组织设定的严格血糖目标。使用地特胰岛素治疗24周后,英国患者的HbA1c降低了1.3%,与全球人群的降低幅度相同;然而,英国患者所需的地特胰岛素剂量高于全球人群。
SOLVE研究英国队列的结果表明,在基层医疗环境中,尽管存在临床惰性,但对于先前口服抗糖尿病药物治疗未达标的患者,改善血糖控制并降低HbA1c是可行的。