Raccah Denis, Guerci Bruno, Ajmera Mayank, Davis Keith, Meyers Juliana, Lew Elisheva, Shaunik Alka, Blonde Lawrence
University Hospital Sainte Marguerite Marseille France.
Diabetology Department University of Lorraine Vandoeuvre-Lès-Nancy France.
Endocrinol Diabetes Metab. 2019 Mar 28;2(3):e00061. doi: 10.1002/edm2.61. eCollection 2019 Jul.
To assess the effect of duration of hyperglycaemia before basal insulin (BI) initiation on clinical outcomes in type 2 diabetes (T2D).
Patients with T2D who initiated BI during 2009-2013, had continuous enrolment for ≥2 years preceding and ≥1 year following BI initiation ("index date"), and had ≥1 glycated haemoglobin (A1C) measure not at target (ie, ≥7.0%) within 6 months preindex date were included in the study. Patients were stratified by preindex-date duration of A1C ≥7.0%. Longitudinal A1C, weight, BMI, and diabetes medication were compared between cohorts for up to 15-month follow-up.
Of 37 053 patients who initiated BI, 40.7%, 15.3%, 16.0%, and 28.0%, respectively, had uncontrolled A1C for <6, 6-<12, 12-<18 and 18-24 months preindex date. Baseline characteristics were similar between cohorts. Baseline A1C values were similar across cohorts (9.2%-9.6%). Mean follow-up A1C values were higher with longer preindex-date duration of uncontrolled A1C (8.0 ± 1.7%, 8.2 ± 1.6%, 8.5 ± 1.7%, and 8.6 ± 1.7% for <6, 6-<12, 12-<18, and 18-24 months); attainment of A1C <7.0% worsened with increasing preindex-date duration of A1C ≥7.0% (29.6%, 20.0%, 14.6%, and 11.5% for <6, 6-<12, 12-<18, and 18-24 months).
These data suggest that longer duration of uncontrolled A1C before BI initiation increases the risk of not reaching glycaemic targets. However, target attainment was poor in all cohorts, highlighting inadequate glycaemic control as an important unmet need in US patients with T2D.
评估基础胰岛素（BI）起始治疗前高血糖持续时间对2型糖尿病（T2D）临床结局的影响。
纳入2009年至2013年期间起始BI治疗的T2D患者，这些患者在BI起始治疗前连续入组≥2年，起始治疗后（“索引日期”）连续入组≥1年，且在索引日期前6个月内有≥1次糖化血红蛋白（A1C）测量值未达目标（即≥7.0%）。患者按索引日期前A1C≥7.0%的持续时间进行分层。对各队列进行长达15个月的随访，比较纵向A1C、体重、BMI和糖尿病用药情况。
在37053例起始BI治疗的患者中，索引日期前A1C未得到控制的时间分别<6个月、6至<12个月、12至<18个月和18至24个月的患者比例分别为40.7%、15.3%、16.0%和28.0%。各队列的基线特征相似。各队列的基线A1C值相似（9.2% - 9.6%）。索引日期前A1C未得到控制的时间越长，平均随访A1C值越高（<6个月、6至<12个月、12至<18个月和18至24个月分别为8.0±(1.7)%、8.2±(1.6)%、8.5±(1.7)%和8.6±(1.7)%）；随着索引日期前A1C≥7.0%持续时间的增加，A1C<7.0%的达标情况变差（<6个月、6至<12个月、12至<18个月和18至24个月分别为29.6%、20.0%、14.6%和11.5%）。
这些数据表明，BI起始治疗前A1C未得到控制的时间越长，未达到血糖目标的风险越高。然而，所有队列的达标情况均较差，突出了血糖控制不佳是美国T2D患者一项重要的未满足需求。
