Endocr Pract. 2018 Sep;24(9):805-814. doi: 10.4158/EP-2017-0261. Epub 2018 Jul 5.
To understand factors associated with intensification of basal insulin therapy and treatment impact on clinical outcomes in patients with type 2 diabetes (T2D).
In this retrospective, observational study of the Practice Fusion electronic health record database, eligible patients were adults with T2D, ≥1 basal insulin prescription and office visit in the 6 months before a glycated hemoglobin A1c (A1C) test >7.0% (index date), and no other injectable prescriptions in the 12 months before the index date. Patients were categorized to intensifiers with injectables (rapid-acting insulin [RAI], glucagon-like peptide-1 receptor agonist [GLP-1 RA], or other injectables) or nonintensifiers with injectables (including no change, adding an oral antidiabetes drug, or changing basal insulin dose). Principal outcomes were A1C change, hypoglycemia incidence, and change in body weight.
Among 14,653 patients, 2,121 (14.5%) and 12,532 (85.5%) were categorized as intensifiers and nonintensifiers with injectables, respectively. Compared with nonintensifiers, intensifiers were more likely to have an endocrinologist as the prescribing physician (odds ratio [OR], 2.52 [95% confidence interval (CI), 2.16 to 2.94]), hypertension (OR, 1.26 [95% CI, 1.08 to 1.47]), higher baseline A1C (OR, 1.22 [95% CI, 1.17 to 1.26]), obesity (OR, 1.17 [95% CI, 1.01 to 1.36]), and higher body mass index (OR, 1.02 [95% CI, 1.01 to 1.03]). In GLP-1 RA intensifiers, the baseline use of dipeptidyl peptidase-4 inhibitors increased the likelihood of intensification. GLP-1 RA intensifiers had equivalent glycemic control to RAI or other injectables, with a nonsignificantly lower risk of hypoglycemia and reduction in body weight.
Addition of GLP-1 RA to basal insulin may be an effective strategy for overcoming clinical inertia with injectable therapy in patients with T2D.
A1C = glycated hemoglobin A1c; BMI = body mass index; CI = confidence interval; DCSI = Diabetes Complications Severity Index; DPP-4 = dipeptidyl peptidase-4; EHR = electronic health record; GLP-1 RA = glucagon-like peptide-1 receptor agonist; ICD-9-CM = International Classification of Diseases-Ninth Revision-Clinical Modification; ICD-10-CM = International Classification of Diseases-Tenth Revision-Clinical Modification; OAD = oral antidiabetes drug; OR = odds ratio; RAI = rapid-acting insulin; SGLT-2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes.
了解与基础胰岛素强化治疗相关的因素及对 2 型糖尿病（T2D）患者临床结局的治疗影响。
本研究是对 Practice Fusion 电子健康记录数据库进行的回顾性、观察性研究，纳入标准为：有 T2D 病史、在糖化血红蛋白（A1C）检测 >7.0%（索引日期）前 6 个月内至少有 1 次基础胰岛素处方和就诊记录、索引日期前 12 个月内无其他注射类药物处方的成年患者。根据是否使用注射类药物（速效胰岛素[RAI]、胰高血糖素样肽-1 受体激动剂[GLP-1 RA]或其他注射类药物）强化治疗，将患者分为强化治疗组和非强化治疗组。主要结局指标为 A1C 变化、低血糖发生率和体重变化。
在 14653 例患者中，2121 例（14.5%）和 12532 例（85.5%）患者分别被归类为强化治疗组和非强化治疗组使用注射类药物。与非强化治疗组相比，强化治疗组更可能由内分泌医生开具处方（比值比[OR]，2.52[95%置信区间[CI]，2.16 至 2.94]）、患有高血压（OR，1.26[95%CI，1.08 至 1.47]）、基线 A1C 更高（OR，1.22[95%CI，1.17 至 1.26]）、肥胖（OR，1.17[95%CI，1.01 至 1.36]）和更高的体重指数（OR，1.02[95%CI，1.01 至 1.03]）。在 GLP-1 RA 强化治疗组中，基线使用二肽基肽酶-4 抑制剂可增加强化治疗的可能性。GLP-1 RA 强化治疗组的血糖控制与 RAI 或其他注射类药物相当，低血糖风险和体重减轻风险无显著差异。
在 T2D 患者中，在基础胰岛素治疗中添加 GLP-1 RA 可能是克服注射类药物治疗临床惰性的有效策略。
