Author(s): Hanefeld M, Fleischmann H, Schiffhorst G, Bramlage P
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Abstract BACKGROUND: It was the aim of this study to assess baseline predictors for glycosylated hemoglobin (HbA1c) reduction, treatment-to-target, and insulin glargine dose in patients with an HbA1c level of ≥ 7.5\% (58 mmol/mol) at baseline despite 3 months of maximum tolerated dose of metformin under daily conditions. SUBJECTS AND METHODS: This was an open, multicenter, prospective observational study with a 6-month follow-up including 1,438 patients with type 2 diabetes. Baseline variables independently associated with HbA1c (overall reduction and achievement of target values) and insulin glargine dose used were determined using a stepwise multivariate linear regression analysis. RESULTS: In a multivariate linear regression analysis (R(2)=0.545) baseline HbA1c (β=-0.722; P<0.001) and retinopathy (β=-0.064; P=0.007) were associated with a greater HbA1c reduction at 6 months, whereas duration of diabetes was associated with a lesser HbA1c reduction (β=0.084; P<0.001). In another multivariate linear regression analysis, weight (odds ratio [OR] 0.99; 95\% confidence interval [CI] 0.98 to <1.00), duration of diabetes (OR 0.96; 95\% CI 0.93-0.99), and baseline HbA1c (OR 0.65; 95\% CI 0.56-0.76) were associated with a reduced likelihood of achieving an HbA1c level of <7\% (53 mmol/mol); baseline HbA1c (OR 0.66; 95\% CI 0.51-0.85) was the only variable associated with a reduced likelihood of achieving an HbA1c level of <6.5\% (48 mmol/mol). In a further analysis (R(2)=0.135) the insulin dose needed was increased in those with a higher body weight (β=0.230; P<0.001), a longer duration of diabetes (β=0.134; P<0.001), a higher baseline HbA1c level (β=0.205; P<0.001), and the presence of microalbuminuria (β=0.096; P=0.003). CONCLUSIONS: Identified predictors of greater HbA1c reduction, target goal achievement, and insulin dose needed may help to optimize the balance of benefits and risks with the use of insulin glargine.
This article was published in Diabetes Technol Ther
and referenced in Journal of Diabetes & Metabolism