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Treatment intensification using long-acting insulin -predictors of future basal insulin supported oral therapy in the DIVE registry.

Danne T, Bluhmki T, Seufert J, Kaltheuner M, Rathmann W, Beyersmann J, Bramlage P, DIVE study gro - BMC Endocr Disord (2015)

Bottom Line: We aimed to identify patient related variables associated with the addition of basal insulin to oral therapy resulting in a basal supported oral therapy (BOT).Analysis of the DIVE registry has resulted in the identification of a number of factors that may be predictive for the initiation of BOT for type-2 diabetes patients initially prescribed one or more OADs.The close monitoring of patients displaying these characteristics may help to identify individuals who might benefit from early addition of insulin therapy to their oral treatment regimen.

View Article: PubMed Central - PubMed

Affiliation: Kinder- und Jugendkrankenhaus "AUF DER BULT", Hannover, Germany. danne@hka.de.

ABSTRACT

Background: In patients with type-2 diabetes receiving oral antidiabetic drugs (OADs), the addition of insulin is frequently required to achieve sufficient control over blood glucose levels. It is, however, difficult to predict if, when and in which patients insulin therapy will be needed. We aimed to identify patient related variables associated with the addition of basal insulin to oral therapy resulting in a basal supported oral therapy (BOT).

Methods: DIVE (DIabetes Versorgungs-Evaluation) is a prospective, observational, multi-centre diabetes registry established in Germany in 2011. For the present explorative analysis, 31,008 patients with type-2 diabetes prescribed at least one OAD were included. Patients who had previously received insulin and those over 90 years old were excluded. The event of interest was defined as the initiation of BOT during the observational period. Cause-specific Cox proportional hazards models based on a competing risk framework were applied for risk quantification.

Results: Multivariable adjusted hazard ratios demonstrated that longer diabetes duration, higher BMI, poorer glycaemic control, documentation of any micro- or macrovascular comorbidity, the presence of concomitant non-antidiabetic pharmacotherapies, and greater numbers of prescribed OADs increased the likelihood of BOT initiation. On the other hand BOT initiation was less likely in patients with older age and female gender. Analysing the likelihood of OAD termination without initiation of BOT provided supportive evidence for the variables predictive of BOT initiation.

Discussion: Analysis of the DIVE registry has resulted in the identification of a number of factors that may be predictive for the initiation of BOT for type-2 diabetes patients initially prescribed one or more OADs. Poor glycaemic control, the presence of vascular comorbidities and concomitant medications, and a greater number of OADs were all detected to increase the risk of a switch to BOT. Female gender and younger age showed protective properties.

Conclusions: The close monitoring of patients displaying these characteristics may help to identify individuals who might benefit from early addition of insulin therapy to their oral treatment regimen.

No MeSH data available.


Related in: MedlinePlus

Competing risks model resulting from the observable data and including study-specific criteria. Time origin was set to OAD initiation. Any record of insulin use prior to baseline led to exclusion. Study entry (baseline) took place when firstly OAD prescription was recorded (state 0). State 1 represents BOT initiation, state 2 represents stopping OAD medication without BOT initiation being observed. Individuals with neither of these two events within the observational period were right-censored
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Fig1: Competing risks model resulting from the observable data and including study-specific criteria. Time origin was set to OAD initiation. Any record of insulin use prior to baseline led to exclusion. Study entry (baseline) took place when firstly OAD prescription was recorded (state 0). State 1 represents BOT initiation, state 2 represents stopping OAD medication without BOT initiation being observed. Individuals with neither of these two events within the observational period were right-censored

Mentions: For the current, explorative analysis, we considered only patients with type-2 diabetes and locked the data October 31st 2014. Time origin was set to OAD initiation with at least one OAD (Fig. 1) that might have occurred even before start of DIVE registry was allocated to the first recorded OAD therapy since the start of DIVE-database. Patients already receiving any insulin therapy and patients older than 90 years were excluded (Figs. 1 and 2).Fig. 1


Treatment intensification using long-acting insulin -predictors of future basal insulin supported oral therapy in the DIVE registry.

Danne T, Bluhmki T, Seufert J, Kaltheuner M, Rathmann W, Beyersmann J, Bramlage P, DIVE study gro - BMC Endocr Disord (2015)

Competing risks model resulting from the observable data and including study-specific criteria. Time origin was set to OAD initiation. Any record of insulin use prior to baseline led to exclusion. Study entry (baseline) took place when firstly OAD prescription was recorded (state 0). State 1 represents BOT initiation, state 2 represents stopping OAD medication without BOT initiation being observed. Individuals with neither of these two events within the observational period were right-censored
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597397&req=5

Fig1: Competing risks model resulting from the observable data and including study-specific criteria. Time origin was set to OAD initiation. Any record of insulin use prior to baseline led to exclusion. Study entry (baseline) took place when firstly OAD prescription was recorded (state 0). State 1 represents BOT initiation, state 2 represents stopping OAD medication without BOT initiation being observed. Individuals with neither of these two events within the observational period were right-censored
Mentions: For the current, explorative analysis, we considered only patients with type-2 diabetes and locked the data October 31st 2014. Time origin was set to OAD initiation with at least one OAD (Fig. 1) that might have occurred even before start of DIVE registry was allocated to the first recorded OAD therapy since the start of DIVE-database. Patients already receiving any insulin therapy and patients older than 90 years were excluded (Figs. 1 and 2).Fig. 1

Bottom Line: We aimed to identify patient related variables associated with the addition of basal insulin to oral therapy resulting in a basal supported oral therapy (BOT).Analysis of the DIVE registry has resulted in the identification of a number of factors that may be predictive for the initiation of BOT for type-2 diabetes patients initially prescribed one or more OADs.The close monitoring of patients displaying these characteristics may help to identify individuals who might benefit from early addition of insulin therapy to their oral treatment regimen.

View Article: PubMed Central - PubMed

Affiliation: Kinder- und Jugendkrankenhaus "AUF DER BULT", Hannover, Germany. danne@hka.de.

ABSTRACT

Background: In patients with type-2 diabetes receiving oral antidiabetic drugs (OADs), the addition of insulin is frequently required to achieve sufficient control over blood glucose levels. It is, however, difficult to predict if, when and in which patients insulin therapy will be needed. We aimed to identify patient related variables associated with the addition of basal insulin to oral therapy resulting in a basal supported oral therapy (BOT).

Methods: DIVE (DIabetes Versorgungs-Evaluation) is a prospective, observational, multi-centre diabetes registry established in Germany in 2011. For the present explorative analysis, 31,008 patients with type-2 diabetes prescribed at least one OAD were included. Patients who had previously received insulin and those over 90 years old were excluded. The event of interest was defined as the initiation of BOT during the observational period. Cause-specific Cox proportional hazards models based on a competing risk framework were applied for risk quantification.

Results: Multivariable adjusted hazard ratios demonstrated that longer diabetes duration, higher BMI, poorer glycaemic control, documentation of any micro- or macrovascular comorbidity, the presence of concomitant non-antidiabetic pharmacotherapies, and greater numbers of prescribed OADs increased the likelihood of BOT initiation. On the other hand BOT initiation was less likely in patients with older age and female gender. Analysing the likelihood of OAD termination without initiation of BOT provided supportive evidence for the variables predictive of BOT initiation.

Discussion: Analysis of the DIVE registry has resulted in the identification of a number of factors that may be predictive for the initiation of BOT for type-2 diabetes patients initially prescribed one or more OADs. Poor glycaemic control, the presence of vascular comorbidities and concomitant medications, and a greater number of OADs were all detected to increase the risk of a switch to BOT. Female gender and younger age showed protective properties.

Conclusions: The close monitoring of patients displaying these characteristics may help to identify individuals who might benefit from early addition of insulin therapy to their oral treatment regimen.

No MeSH data available.


Related in: MedlinePlus