Observational Registry of Basal Insulin Treatment (ORBIT) in patients with type 2 diabetes uncontrolled with oral antihyperglycaemic drugs: Real‐life use of basal insulin in China

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2017-06, Vol.19 (6), p.822-830
• Main Authors: Ji, Linong, Zhang, Puhong, Zhu, Dongshan, Li, Xian, Ji, Jiachao, Lu, Juming, Guo, Xiaohui, Jia, Weiping, Weng, Jianping, Wu, Yangfeng, Yang, Wenying, Zou, Dajin, Zhou, Zhiguang, Pan, Changyu, Gao, Yan, Garg, Satish K.
• Format: Article
• Language: English
• Subjects: Aged; basal insulin; Blood Glucose - drug effects; China; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Drug dosages; Drug Therapy, Combination; Female; Glycated Hemoglobin A - drug effects; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemic Agents - administration & dosage; Insulin; Insulin, Long-Acting - administration & dosage; Male; Middle Aged; observational study; Patients; Protamine sulfate; Registries; Titration; Treatment Outcome; type 2 diabetes
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.12886

Aims To examine treatment patterns following basal insulin (BI) introduction in type 2 diabetes mellitus (T2DM) patients under real‐world conditions across China. Materials and methods Overall, 18 995 patients inadequately controlled (HbA1c ≥ 53 mmol/mol [7%]) with oral antihyperglycaemic drugs (OADs) and willing to receive BI treatment were registered at 209 hospitals and followed at baseline (visit 1), 3 months (visit 2) and 6 months (visit 3). Type of BI was initiated at physicians’ discretion. Results Retention with BI therapy at 6 months was 75.6%. Use of long‐acting BI predominated, with insulin glargine accounting for 71%, detemir 13% and Neutral Protamine Hagedorn (NPH) insulin 16%. Over 70% of long‐acting users maintained the same initial BI at visit 3, while 40% of NPH users switched treatment and 24.4% of participants initiated BI with prandial insulin. The initial mean (± SD) dose of BI and total insulin was 0.18 ± 0.07 and 0.25 ± 0.19 IU/kg, respectively, with a mean increase of daily dose by 0.03 and 0.02 IU/kg after 6 months, respectively. Only 56.6% of insulin users reported dose titration at visit 3. Mean HbA1c was 81 mmol/mol (9.6%) at baseline and 57 mmol/mol (7.4%) at 6 months. The frequency of hypoglycaemia was 1.61 and 2.07 episodes/patient‐year at baseline and 6 months, respectively. Conclusions In real‐world clinical settings, add‐on BI therapy in T2DM patients is associated with significant improvement in glycaemic control without overtly compromising safety related to hypoglycaemia and weight gain. Evolution of insulin treatment regimens varied among patients, but dose titration was suboptimal. More active BI dose titration might further improve glycaemic outcome in patients receiving BI therapy. Video A free Video to accompany this article is available at https://vimeo.com/212655959 Video : A free Video to accompany this article is available at https://vimeo.com/212655959