Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12749
Title: What happens when patients require intensification from basal insulin? A retrospective audit of clinical practice for the treatment of type 2 diabetes from four Australian centres.
Authors: Fulcher, Gregory;Roberts, Anthony;Sinha, Ashim;Proietto, Joseph
Affiliation: Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Sydney, 2006 NSW, Australia. Electronic address: greg.fulcher@sydney.edu.au.
South Australian Endocrine Clinical Research, 8A Hampton Rd, Keswick, 5035 SA, Australia. Electronic address: drtony@aproberts.com.au.
Cairns Base Hospital and Diabetes Centre, 381 Sheridan St, Cairns, 4870 QLD, Australia. Electronic address: ashim_sinha@health.qld.gov.au.
Department of Medicine, Austin Health, University of Melbourne, 145 Studley Rd, Heidelberg, 3084 VIC, Australia. Electronic address: j.proietto@unimelb.edu.au.
Issue Date: 14-Mar-2015
Citation: Diabetes Research and Clinical Practice 2015; 108(3): 405-13
Abstract: Little is known about clinical practices beyond the initiation of basal insulin in patients with type 2 diabetes mellitus (T2DM) in Australia. To determine the proportion of patients who progressed from basal insulin to each of three possible therapy groups: Group 1 addition of rapid-acting insulin, Group 2 switch to pre-mixed insulin, Group 3 addition of another therapy (incretin, glitazone, sulphonylurea, metformin, acarbose).Retrospective audit across four Australian hospital clinics. Patients had a diagnosis of T2DM, basal insulin had been initiated and a subsequent treatment intensification/change had occurred during the analysis period (September 2007-March 2012).Patients were classified into one of three intensification groups for analysis: Group 1, 56.1% (111/198); Group 2, 22.7% (45/198) and Group 3, 21.2% (42/198). Prior to basal insulin initiation, mean T2DM duration was 11 years. Between starting basal insulin and treatment intensification, 42/183 (22.9%) patients achieved the HbA1c target of <7.0% (53mmol/mol). Initiation of basal insulin provided temporary improvement in glycaemic control followed by subsequent deterioration. With further treatment intensification, only 40/180 (22.2%) patients achieved the HbA1c target of <7.0% (53mmol/mol). Patients in the insulin groups gained weight (Group 1, rapid acting insulin, 1.9±7.4kg; Group 2, premixed insulin 2.3±4.8kg); those in Group 3 lost weight (-0.9±13.54kg). Hypoglycaemic episodes were uncommon irrespective of group.There is continued need for improved patient management; individualised strategies should focus on when to initiate insulin, how to adjust and optimise doses over time and, when required, the introduction of intensification regimens.
Internal ID Number: 25887419
URI: http://ahro.austin.org.au/austinjspui/handle/1/12749
DOI: 10.1016/j.diabres.2015.03.004
URL: http://www.ncbi.nlm.nih.gov/pubmed/25887419
Type: Journal Article
Subjects: Drug utilisation
Glycaemic control
Incretin therapy
Insulin therapy
Medicines management
Appears in Collections:Journal articles

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