The probability of reaching the glycemic goal of A1C <7.0% in T2D patients, who initiated basal insulin (BI) after being uncontrolled on oral therapy, was investigated using real-world data extracted from the Optum Humedica EMR database.
The cohort comprised 70,288 patients whose baseline A1C was obtained ≤90 days prior to BI initiation (index date). Baseline characteristics were mean age (59 years), mean BMI (34.1 kg/m2), mean A1C (9.8%), mean FPG (190.6 mg/dL), gender (53% males), and race (74.8% Caucasian, 14.2% African American, 2.3% Asian American).
Mean A1C increased from 8.5% to 9.8% in the 6 months prior to BI initiation while still on oral therapy, declined to about 8.2% at 3 months post index date, and then remained steady for 24 months. The Kaplan-Meier curve for reaching the glycemic goal (A1C <7.0%) had a steep increasing slope in the first 12 months but remained flat during the following 12 months. Achieving the glycemic goal was less likely in patients with higher baseline A1C. Lower baseline A1C correlated with persistence of index medications (mean duration 574.1, 489.3, and 479.3 days for sub-cohorts with baseline A1C 7.0-8.0%, 8.0-9.0%, and ≥9.0%, respectively). Adjusted proportional hazards analyses showed a higher probability of reaching A1C <7.0% with ages 18-34 years or 55-64 years, male gender, Caucasian race, and non-Hispanic ethnicity. Lower probability of reaching the glycemic goal was seen in patients with A1C ≥8.0% or coronary heart disease, neuropathy, peripheral vascular disease, or retinopathy comorbidities (potentially indicative of longer disease duration).
These results suggest that if an A1C goal <7.0% is not achieved within 12 months post BI initiation, the likelihood of achieving glycemic control diminishes thereafter. Clinicians should consider additional therapeutic options for their patients if T2D is still inadequately controlled 12 months after BI initiation.
X.V. Peng: Employee; Self; Sanofi. Stock/Shareholder; Spouse/Partner; AbbVie Inc. Stock/Shareholder; Self; AbbVie Inc., Sanofi. P.R. Hunt: Consultant; Self; AstraZeneca, Sanofi. T.A. Dex: Stock/Shareholder; Self; Merck & Co., Inc., Pfizer Inc., Sanofi US. R. Lubwama: Employee; Self; Merck & Co., Inc., Sanofi. N. Skolnik: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., GlaxoSmithKline plc., Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Mylan, Sanofi, Teva Pharmaceutical Industries Ltd. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., GlaxoSmithKline plc., Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. L. Blonde: Consultant; Self; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Research Support; Self; Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US.