Robust type 2 diabetes response to insulin not guaranteed in real world
medwireNews: Around one in six patients with type 2 diabetes have a poor or short-lived response when they start insulin in clinical practice, researchers warn.
Grigory Sidorenkov (University Medical Center Groningen, the Netherlands) and team modeled glycated hemoglobin (HbA1c) data from 1459 patients in the Groningen Initiative to Analyze Type 2 Diabetes Treatment database who had at least 2 years of follow-up after insulin initiation. They found distinct trajectories of response: a poor response; an initial large improvement followed by deterioration; and a stable response.
They note that their findings are broadly in line with a previous, similar study. Although the older study found four response trajectories, whereas the current one identified three, both studies “clearly showed” a distinct group of poor responders.
In the current study, 119 patients fell into this category. Their average baseline HbA1c level was around 70.1 mmol/mol, and although this declined to 60.1 mmol/mol during the first 6 months of insulin use, it then rose again to an average of 73.0 mmol/mol after 2.5 years.
This poor response was despite these patients being more likely to be taking sulfonylureas at baseline, at 71.4% versus 54–63% of the other groups. They were also more likely to continue taking them after insulin initiation, and to be prescribed metformin.
“This suggests that the higher HbA1c levels were not caused by clinical inertia, but non-adherence may be an issue that needs to be addressed in poor responders,” the researchers write in Diabetes, Obesity and Metabolism.
Indeed, both the current and former study found that poor responders were generally younger, at 60 versus 66–69 years of age for the other groups in the current study. The team notes that such people “may have a more irregular lifestyle and more problems with adherence to treatment with insulin.”
However, two very recent studies have shown early-onset type 2 diabetes to be characterized by a particularly high mortality rate, implying the existence of a high-risk etiology.
The second response group, which included 113 patients, had very high HbA1c levels at baseline, averaging 87.9 mmol/mol. These declined rapidly during the 1.5 years of treatment, to nearly as low as 50 mmol/mol, but then rose again to exceed 60 mmol/mol by the third year of follow-up. The researchers note that the initial rapid reduction in HbA1c levels suggests a lack of response to non-insulin antidiabetic agents, implying that this group could have included some unrecognized cases of latent autoimmune diabetes of adults.
The third and largest response group included 1227 patients. Their average HbA1c levels declined from around 65 to 60 mmol/mol over the first 6 months of insulin use and remained at around 57 mmol/mol during up to 4 years of follow-up.
“Our findings emphasize the importance of more personalized care approaches in the process of initiation and management of insulin treatment in patients with [type 2 diabetes],” the researchers conclude.
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