A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study
Summary Aims: Insulin is normally added to oral glucose‐lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins. Methods: Insulin‐...
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| Veröffentlicht in: | International journal of clinical practice (Esher) 2010-11, Vol.64 (12), p.1609-1618 |
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| container_title | International journal of clinical practice (Esher) |
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| creator | Gordon, J. Pockett, R. D. Tetlow, A. P. McEwan, P. Home, P. D. |
| description | Summary
Aims: Insulin is normally added to oral glucose‐lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins.
Methods: Insulin‐naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA1c≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate‐adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis.
Results: In the study population (n = 4337), baseline HbA1c was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change −1.1 ± 1.8%, p |
| doi_str_mv | 10.1111/j.1742-1241.2010.02520.x |
| format | Article |
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Aims: Insulin is normally added to oral glucose‐lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins.
Methods: Insulin‐naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA1c≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate‐adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis.
Results: In the study population (n = 4337), baseline HbA1c was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change −1.1 ± 1.8%, p < 0.001). Compared with NPH, people taking detemir, glargine and premix had an adjusted reduction in HbA1c from baseline, of 0.00% (p = 0.99), 0.19% (p < 0.001) and 0.03% (p = 0.51). Body weight increased by 2.8 kg overall (p < 0.001), and by 2.3, 1.7, 1.9, and 3.3 kg on NPH, detemir, glargine and premix (p < 0.001 for all groups); insulin dose at 12 months was 0.70 (overall), 0.64, 0.61, 0.56 and 0.76 U/kg/day. After 36 months, 57% of people on NPH, 67% on glargine and 83% on premix remained on their initially prescribed insulin.
Discussion and Conclusion: In routine clinical practice, people with type 2 diabetes commenced on NPH experienced a modest disadvantage in glycaemic control after 12 months compared with other insulins. When comparing the insulins, glargine achieved best HbA1c reduction, while premix showed greatest weight gain and the highest dose requirement, but had the best persistence of therapy.</description><identifier>ISSN: 1368-5031</identifier><identifier>EISSN: 1742-1241</identifier><identifier>DOI: 10.1111/j.1742-1241.2010.02520.x</identifier><identifier>PMID: 20946269</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Administration, Oral ; Biological and medical sciences ; Comparative studies ; Diabetes ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes. Impaired glucose tolerance ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Endocrine ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; General aspects ; Glycated Hemoglobin - metabolism ; Humans ; Hypoglycemia - chemically induced ; Hypoglycemic Agents - administration & dosage ; Insulin ; Insulin Detemir ; Insulin Glargine ; Insulin, Long-Acting - administration & dosage ; Insulins - administration & dosage ; Male ; Medical sciences ; Medication Adherence ; Middle Aged ; Treatment Outcome ; Weight Gain - drug effects ; Young Adult</subject><ispartof>International journal of clinical practice (Esher), 2010-11, Vol.64 (12), p.1609-1618</ispartof><rights>2010 Blackwell Publishing Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2010 Blackwell Publishing Ltd.</rights><rights>Copyright © 2010 Blackwell Publishing Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5690-368ce6859b7ace889abaf8430d094be0e696d747d5ab6e01e8fb810a6143d673</citedby><cites>FETCH-LOGICAL-c5690-368ce6859b7ace889abaf8430d094be0e696d747d5ab6e01e8fb810a6143d673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1742-1241.2010.02520.x$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1742-1241.2010.02520.x$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23292925$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20946269$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gordon, J.</creatorcontrib><creatorcontrib>Pockett, R. D.</creatorcontrib><creatorcontrib>Tetlow, A. P.</creatorcontrib><creatorcontrib>McEwan, P.</creatorcontrib><creatorcontrib>Home, P. D.</creatorcontrib><title>A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study</title><title>International journal of clinical practice (Esher)</title><addtitle>Int J Clin Pract</addtitle><description>Summary
Aims: Insulin is normally added to oral glucose‐lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins.
Methods: Insulin‐naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA1c≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate‐adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis.
Results: In the study population (n = 4337), baseline HbA1c was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change −1.1 ± 1.8%, p < 0.001). Compared with NPH, people taking detemir, glargine and premix had an adjusted reduction in HbA1c from baseline, of 0.00% (p = 0.99), 0.19% (p < 0.001) and 0.03% (p = 0.51). Body weight increased by 2.8 kg overall (p < 0.001), and by 2.3, 1.7, 1.9, and 3.3 kg on NPH, detemir, glargine and premix (p < 0.001 for all groups); insulin dose at 12 months was 0.70 (overall), 0.64, 0.61, 0.56 and 0.76 U/kg/day. After 36 months, 57% of people on NPH, 67% on glargine and 83% on premix remained on their initially prescribed insulin.
Discussion and Conclusion: In routine clinical practice, people with type 2 diabetes commenced on NPH experienced a modest disadvantage in glycaemic control after 12 months compared with other insulins. When comparing the insulins, glargine achieved best HbA1c reduction, while premix showed greatest weight gain and the highest dose requirement, but had the best persistence of therapy.</description><subject>Administration, Oral</subject><subject>Biological and medical sciences</subject><subject>Comparative studies</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Therapy, Combination</subject><subject>Endocrine</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>General aspects</subject><subject>Glycated Hemoglobin - metabolism</subject><subject>Humans</subject><subject>Hypoglycemia - chemically induced</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Insulin</subject><subject>Insulin Detemir</subject><subject>Insulin Glargine</subject><subject>Insulin, Long-Acting - administration & dosage</subject><subject>Insulins - administration & dosage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medication Adherence</subject><subject>Middle Aged</subject><subject>Treatment Outcome</subject><subject>Weight Gain - drug effects</subject><subject>Young Adult</subject><issn>1368-5031</issn><issn>1742-1241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNqNUdtu1DAQjRCIlsIvIAuJxyx2Lo7DA1JZQSmquEjV7qM1SSZbL9k42E67-wN8NxN22ZY3bMkeec6cmeMTRUzwmaD1Zj0TRZbEIsnELOH0ypM84bPto-j0mHhMcSpVnPNUnETPvF9zQuWKP41OEl5mMpHlafTrnNV2M4Az3vbMtsz0Ad0GGwMBGfQN62y_iqEOpl9R0o8dHRSwAe3QIbsz4YaF3YAsYVRUYUDPfAD3sOAtMTFbeXS3EIztoWMNBKjAI2HHZvc8etJC5_HF4T6Lrj9-uJ5_iq--XlzOz6_iOpclj0lPjVLlZVVAjUqVRNGqLOUNCaqQoyxlU2RFk0MlkQtUbaUEBymytJFFeha929MOY0Uaa-yDg04PzmzA7bQFo__N9OZGr-ytTjm1FjkRvDoQOPtzRB_02o6O9Hhd5EplRZoKAqk9qHbWe4ftsYHgevJPr_Vkk55s0pN_-o9_ekulLx8OeCz8axgBXh8A4GvoWgd9bfw9Lk1K2vm90jvT4e6_B9CXn-ffppAI4j2B8QG3RwJwPzR9ZJHr5ZcLzZffl-8XC64X6W8-a8j8</recordid><startdate>201011</startdate><enddate>201011</enddate><creator>Gordon, J.</creator><creator>Pockett, R. D.</creator><creator>Tetlow, A. P.</creator><creator>McEwan, P.</creator><creator>Home, P. D.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Hindawi Limited</general><scope>BSCLL</scope><scope>24P</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TK</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>201011</creationdate><title>A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study</title><author>Gordon, J. ; Pockett, R. D. ; Tetlow, A. P. ; McEwan, P. ; Home, P. D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5690-368ce6859b7ace889abaf8430d094be0e696d747d5ab6e01e8fb810a6143d673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Administration, Oral</topic><topic>Biological and medical sciences</topic><topic>Comparative studies</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Therapy, Combination</topic><topic>Endocrine</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>General aspects</topic><topic>Glycated Hemoglobin - metabolism</topic><topic>Humans</topic><topic>Hypoglycemia - chemically induced</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Insulin</topic><topic>Insulin Detemir</topic><topic>Insulin Glargine</topic><topic>Insulin, Long-Acting - administration & dosage</topic><topic>Insulins - administration & dosage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medication Adherence</topic><topic>Middle Aged</topic><topic>Treatment Outcome</topic><topic>Weight Gain - drug effects</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gordon, J.</creatorcontrib><creatorcontrib>Pockett, R. D.</creatorcontrib><creatorcontrib>Tetlow, A. P.</creatorcontrib><creatorcontrib>McEwan, P.</creatorcontrib><creatorcontrib>Home, P. D.</creatorcontrib><collection>Istex</collection><collection>Wiley Online Library Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of clinical practice (Esher)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gordon, J.</au><au>Pockett, R. D.</au><au>Tetlow, A. P.</au><au>McEwan, P.</au><au>Home, P. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study</atitle><jtitle>International journal of clinical practice (Esher)</jtitle><addtitle>Int J Clin Pract</addtitle><date>2010-11</date><risdate>2010</risdate><volume>64</volume><issue>12</issue><spage>1609</spage><epage>1618</epage><pages>1609-1618</pages><issn>1368-5031</issn><eissn>1742-1241</eissn><abstract>Summary
Aims: Insulin is normally added to oral glucose‐lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins.
Methods: Insulin‐naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA1c≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate‐adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis.
Results: In the study population (n = 4337), baseline HbA1c was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change −1.1 ± 1.8%, p < 0.001). Compared with NPH, people taking detemir, glargine and premix had an adjusted reduction in HbA1c from baseline, of 0.00% (p = 0.99), 0.19% (p < 0.001) and 0.03% (p = 0.51). Body weight increased by 2.8 kg overall (p < 0.001), and by 2.3, 1.7, 1.9, and 3.3 kg on NPH, detemir, glargine and premix (p < 0.001 for all groups); insulin dose at 12 months was 0.70 (overall), 0.64, 0.61, 0.56 and 0.76 U/kg/day. After 36 months, 57% of people on NPH, 67% on glargine and 83% on premix remained on their initially prescribed insulin.
Discussion and Conclusion: In routine clinical practice, people with type 2 diabetes commenced on NPH experienced a modest disadvantage in glycaemic control after 12 months compared with other insulins. When comparing the insulins, glargine achieved best HbA1c reduction, while premix showed greatest weight gain and the highest dose requirement, but had the best persistence of therapy.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20946269</pmid><doi>10.1111/j.1742-1241.2010.02520.x</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Administration, Oral Biological and medical sciences Comparative studies Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - drug therapy Diabetes. Impaired glucose tolerance Dose-Response Relationship, Drug Drug Therapy, Combination Endocrine Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female General aspects Glycated Hemoglobin - metabolism Humans Hypoglycemia - chemically induced Hypoglycemic Agents - administration & dosage Insulin Insulin Detemir Insulin Glargine Insulin, Long-Acting - administration & dosage Insulins - administration & dosage Male Medical sciences Medication Adherence Middle Aged Treatment Outcome Weight Gain - drug effects Young Adult |
| title | A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study |
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