van Brunt Kate, Curtis Bradley, Ivanyi Tibor, Balogh Elemer, Chalkiadaki Corina, MacLachlan Sharon, Neasham David, Raluy-Callado Mireia
Eli Lilly and Company, Wood Manor, Surrey, UK.
Evidera, Hammersmith, UK.
Diabetes Ther. 2016 Dec;7(4):793-807. doi: 10.1007/s13300-016-0209-4. Epub 2016 Oct 31.
Increasing emphasis is being placed on insulin use among patients with type 2 diabetes mellitus (T2DM). Basal-bolus (BB) therapy is regarded as the gold standard, but a high frequency of injections and the general complexity of this therapy are seen as barriers in real-world practice. Here we describe the characteristics and treatment patterns of patients with T2DM receiving BB in the UK, with specific focus on those switching to a simplified regimen of premixed insulin.
Patients with T2DM receiving BB from 1 January 2005 were identified from the Clinical Practice Research Datalink. Characteristics were described at treatment initiation or on 1 January 2005, and treatment patterns were assessed at 12 months of follow-up. Clinical factors were compared in two groups of patients who while receiving BB had one haemoglobin A1c (HbA1c) measurement of ≥53 mmol/mol (7.0%) and remained either on BB or switched to a premixed insulin regimen.
Study criteria were met by 12,060 subjects (mean age 59 years; duration diabetes 12.4 years). The mean HbA1c concentration was 76 mmol/mol (9.1% of patients), and 84.0% of patients were overweight. At 12 months of follow-up, 74.5% of the patients who had started BB remained on it. While on BB, 8835 patients had a HbA1c measurement of ≥53 mmol/mol (7.0% of all patients); of these, 95.9% remained on BB and 4.1% switched to premixed insulin. Mean HbA1c levels were consistently higher for patients who switched to premixed insulin than for those who remained on BB, but the levels remained relatively unchanged over time.
A large proportion of patients receiving insulin did not achieve good glycaemic control in clinical practice. A small subset with higher comorbidities and HbA1c levels switched to a simplified regimen. Little evidence was found that type of insulin therapy was associated with meaningful changes in key clinical factors over time.
Eli Lilly and company.
2型糖尿病（T2DM）患者对胰岛素使用的重视程度日益提高。基础-餐时（BB）疗法被视为金标准，但在实际临床中，高频率注射以及该疗法的复杂性被视为障碍。在此，我们描述了英国接受BB治疗的T2DM患者的特征和治疗模式，特别关注那些改用简化预混胰岛素方案的患者。
从临床实践研究数据链中识别出2005年1月1日起接受BB治疗的T2DM患者。在治疗开始时或2005年1月1日描述其特征，并在随访12个月时评估治疗模式。对两组接受BB治疗且糖化血红蛋白（HbA1c）测量值≥53 mmol/mol（7.0%）的患者的临床因素进行比较，一组继续使用BB治疗，另一组改用预混胰岛素方案。
12060名受试者符合研究标准（平均年龄59岁；糖尿病病程12.4年）。平均HbA1c浓度为76 mmol/mol（占患者的9.1%），84.0%的患者超重。随访12个月时，开始接受BB治疗的患者中有74.5%仍继续使用该方案。在使用BB治疗期间，8835名患者的HbA1c测量值≥53 mmol/mol（占所有患者的7.0%）；其中，95.9%的患者继续使用BB治疗，4.1%的患者改用预混胰岛素。改用预混胰岛素的患者的平均HbA1c水平始终高于继续使用BB治疗的患者，但随着时间推移，这些水平相对保持不变。
在临床实践中，很大一部分接受胰岛素治疗的患者未实现良好的血糖控制。一小部分合并症和HbA1c水平较高的患者改用了简化方案。几乎没有证据表明胰岛素治疗类型会随着时间推移在关键临床因素上产生有意义的变化。
礼来公司。
