jueves, 7 de octubre de 2010

A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study

Estudio muy importante, es de la vida real, NO es un estudio de laboratorio con esquemas y algoritmos controlados.

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.

Ésta es la conclusión final: In summary, in real clinical practice in the UK, in people with suboptimal glycaemic control with OGLDs and lifestyle therapy, insulin is an effective strategy in reducing HbA1c levels. People commenced on NPH have a modest overall disadvantage in outcomes when compared with other insulins. Between group comparisons showed that HbA1c reductions were greater with insulin glargine, while persistence with therapy was best on premix at a cost of modestly greater weight gain and higher insulin dosage.

J. Gordon, R. D. Pockett, A. P. Tetlow, P. McEwan and P. D. HomeArticle first published online: 4 OCT 2010 DOI: 10.1111/j.1742-1241.2010.02520.x

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