Background: To investigate the different efficacies of glycemic control between basal and premixed insulin in participants with type 2 diabetes (T2DM) when non-insulin medications fail to reach treatment targets.
Methods: This was a prospective, large-scale, real-world study at 10 diabetes centers in China. Between June 2017 and June 2021, we enrolled 1104 T2DM participants initiated with either once-daily basal insulin or twice-daily premixed insulin when the glycosylated hemoglobin (HbA1c) control target was not met after at least two non-insulin agents were administered. A Cox proportional hazards regression model adjusting for multiple influencing factors was performed to compare the different effects of basal and premixed insulin on reaching the HbA1c control target.
Results: At baseline, basal insulin (57.3%) was prescribed more frequently than premixed insulin (42.7%). Patients with a higher body mass index (BMI) or higher HbA1c levels were more likely to receive premixed insulin than basal insulin (both p < 0.001). After a median follow-up of 12.0 months, compared to those with premixed insulin, the hazard ratio for reaching the HbA1c target to those with basal insulin was 1.10 (95% CI, 0.92-1.31; p = 0.29) after adjustment, and less weight gain was observed in those with basal insulin than with premixed insulin (percentage change of BMI from baseline -0.37[5.50]% vs 3.40[6.73]%, p < 0.0001).
Conclusions: In this real-world study, once-daily basal insulin was more frequently prescribed and had similar glycemic control effects but less weight gain compared with twice-daily premixed insulin when used as initiation therapy for those in whom glycemic control with non-insulin medications failed.
背景: 探究当非胰岛素降糖药物不能达到控制目标时, 基础胰岛素和预混胰岛素对2型糖尿病(T2DM)患者血糖控制的疗效差异。 方法: 这是一项在中国10个糖尿病中心进行的前瞻性大规模真实世界研究。在2017年6月至2021年6月期间, 我们共纳入了1104位2型糖尿病患者, 均在使用至少两种非胰岛素降糖药治疗时糖化血红蛋白(HbA1c)未达标后开始启用每天一次基础胰岛素或每天两次预混胰岛素治疗。采用Cox比例风险回归模型矫正多个影响因素, 比较基础胰岛素和预混合胰岛素对HbA1c控制的效果。 结果: 基线数据显示, 基础胰岛素的处方频率(57.3%)高于预混胰岛素(42.7%)。体重指数(BMI)或HbA1c水平较高的患者接受预混胰岛素治疗的可能性高于基础胰岛素(P<0.001)。经过中位12个月的随访, 与预混胰岛素组相比, 校正后的基础胰岛素组患者HbA1c达标的风险比(95%CI)为1.10(0.92-1.31, P=0.29), 而体重增加的程度相对较小(BMI增加百分比为-0.37[5.50]% vs. 3.40[6.73]%, P<0.0001)。 结论: 在这项真实世界研究中, 在使用非胰岛素降糖药物血糖控制失败后作为起始治疗时, 每日一次的基础胰岛素与每日两次预混胰岛素治疗方案相比, 前者更为常用。两者虽具有相似的血糖控制效果, 但每日一次的基础胰岛素治疗体重增加更少。.
Keywords: basal insulin; body mass index; glycemic hemoglobin; premixed insulin; type 2 diabetes; 体重指数; 型糖尿病; 基础胰岛素; 糖化血红蛋白; 预混胰岛素.
© 2022 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.