Open AccessBasal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations
Author(s) -
OrozcoBeltran D.,
Pan C.,
Svendsen A. L.,
Færch L.,
Caputo S.
Publication year - 2016
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12776
Subject(s) - medicine , confidence interval , odds ratio , primary care , type 2 diabetes , logistic regression , confounding , insulin , diabetes mellitus , observational study , basal insulin , basal (medicine) , endocrinology , family medicine
Summary Objective To investigate the effect of healthcare provider ( HCP ) type (primary vs. specialist) on glycaemic control and other treatment parameters. Research design and methods Study of Once‐Daily Levemir ( SOLVE ™ ) is an international, 24‐week, observational study of insulin initiation in people with type 2 diabetes. Results A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) −1.2 ± 1.4% (−13.1 ± 15.3 mmol/mol) and −1.3 ± 1.6% (−14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [−0.04%, 95% confidence interval ( CI ) −0.09 to −0.01 (−0.4 mmol/mol, 95% CI −1.0−0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06–0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio ( OR ) 0.75, 95% CI 0.64–0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). Conclusions Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.