alexa Baseline HbA1c predicts attainment of 7.0\% HbA1c target with structured titration of insulin glargine in type 2 diabetes: a patient-level analysis of 12 studies.
Diabetes & Endocrinology

Diabetes & Endocrinology

Journal of Diabetes & Metabolism

Author(s): Riddle MC, Vlajnic A, Zhou R, Rosenstock J

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Abstract AIMS: To determine whether baseline characteristics, especially haemoglobin A1c (HbA1c), predict the likelihood of reaching HbA1c ≤ 7.0\% or the risk of experiencing hypoglycaemia after the addition of insulin glargine to oral therapy in type 2 diabetes. METHODS: Pooled patient-level data from 12 prospective, randomized, controlled studies that used insulin glargine in a treat-to-target titration regimen seeking fasting glucose levels ≤5.5 mmol/l (100 mg/dl) were analysed. Baseline characteristics were evaluated by logistic regression models as predictors of reaching a target HbA1c ≤ 7.0\% or experiencing confirmed hypoglycaemia. The effect of prior glycaemic control was further explored by analysis of categorical ranges of baseline HbA1c. RESULTS: Of 2312 participants, 95\% completed 24 weeks of treatment. Lower HbA1c at baseline was independently associated with reaching HbA1c target [adjusted odds ratio (OR) for 1\% difference: 0.538, p < 0.0001] and also with likelihood of experiencing confirmed hypoglycaemic events (adjusted OR: 0.835, p < 0.0001) at week 24. In an unadjusted analysis by baseline HbA1c range, the strong association between baseline control and attaining target HbA1c was confirmed (75\% with baseline HbA1c < 8.0\%, 60\% with baseline HbA1c ≥ 8.0 and <9.0\% and 38\% with baseline HbA1c ≥ 9.0\% attained HbA1c ≤ 7.0\%). The incidence of hypoglycaemia confirmed <3.9 mmol/l (70 mg/dl) was higher in the lower baseline HbA1c ranges but severe hypoglycaemia was infrequent at all baseline HbA1c levels. CONCLUSIONS: Systematically titrated insulin glargine, added to oral agents, was effective over a wide range of baseline HbA1c. Lower baseline HbA1c was the best clinical predictor of achieving HbA1c ≤ 7.0\% and also associated with higher risk of glucose-confirmed hypoglycaemia. Severe hypoglycaemia was infrequent using this treatment approach. © 2013 Blackwell Publishing Ltd. This article was published in Diabetes Obes Metab and referenced in Journal of Diabetes & Metabolism

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