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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.
Austin Authors: Fulcher, Gregory;Roberts, Anthony;Sinha, Ashim;Proietto, Joseph 
Affiliation: Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Sydney, 2006 NSW, Australia
South Australian Endocrine Clinical Research, 8A Hampton Rd, Keswick, 5035 SA, Australia
Department of Medicine, Austin Health, University of Melbourne, 145 Studley Rd, Heidelberg, 3084 Victoria, Australia
Cairns Base Hospital and Diabetes Centre, 381 Sheridan St, Cairns, 4870 QLD, Australia
Issue Date: 14-Mar-2015
Publication information: 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.
Gov't Doc #: 25887419
DOI: 10.1016/j.diabres.2015.03.004
Type: Journal Article
Subjects: Drug utilisation
Glycaemic control
Incretin therapy
Insulin therapy
Medicines management
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