Blonde L, Brunton SA, Chava P, Zhou R, Meyers J, Davis KL, Dalal MR, Digenio A. Achievement of target A1C <7.0% (<53 mmol/mol) by U.S. type 2 diabetes patients treated with basal insulin in both randomized controlled trials and clinical practice. Diabetes Spectr. 2018 Oct.

OBJECTIVES: Many type 2 diabetes patients do not reach glycemic goals despite basal insulin treatment. This study assessed achievement of target A1c <7.0% (<53 mmol/mol) following initiation of basal insulin in two settings.

METHODS: This was a retrospective analysis of pooled randomized controlled trial (RCT) data, from eleven 24- week studies of patients initiating basal insulin performed between 2000–2005, and of outpatient electronic medical record (EMR) data from the GE Centricity database for insulin-naive patients initiating basal insulin between 2005–2012. Baseline characteristics stratified by target A1c and fasting plasma glucose (FPG) attainment were compared descriptively.

RESULTS: In the RCT dataset, 49.0% of patients failed to achieve target A1c at 6 months, versus 72.4% and 72.9% at 6 and 12 months in the EMR dataset, respectively. Despite this, in the RCT dataset, 79.4% of patients achieved target A1c and/or FPG <130 mg/dL. In the EMR dataset, only 47.6% and 47.3% of patients achieved A1c <7.0% and/or FPG <130 mg/dL at 6 and 12 months, respectively. Overall, patients with A1c >7.0% had longer diabetes duration, were more likely to be female, nonwhite, and self-funding or covered by Medicaid. Among patients with A1c >7.0%, more RCT patients (58.0%) had FPG <130 mg/dL than EMR patients at 6 (27.8%) and 12 months (27.7%).

CONCLUSIONS: Unmet needs remain following basal insulin initiation, particularly in real-world settings, where many patients require further insulin titration. In both populations, patients failing to achieve target A1c despite attaining FPG <130 mg/dL require interventions to improve postprandial control.

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