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Strategies for insulin initiation: insights from the French LIGHT observational study
Author(s) -
Vergès Bruno,
Brun Jean Marcel,
Tawil Camille,
Alexandre Bertrand,
Kerlan Véronique
Publication year - 2012
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.1288
Subject(s) - medicine , insulin detemir , insulin , insulin glargine , diabetes mellitus , observational study , type 2 diabetes , basal (medicine) , clinical endpoint , adverse effect , hypoglycemia , endocrinology , clinical trial
Background The progressive nature of type 2 diabetes necessitates exogenous insulin use for most patients; basal insulin plus oral anti‐diabetes drugs (OADs) is a well‐validated way to facilitate insulin initiation. The primary aim of this study was to explore insulin initiation strategies and outcomes for patients using insulin detemir or glargine plus oral anti‐diabetes drugs. Methods LIGHT was a 3‐month, longitudinal observational study conducted across 761 French centres in insulin‐naïve type 2 diabetes patients managed under routine clinical care conditions, in either primary or secondary care. Endpoints included changes in HbA 1c , fasting plasma glucose (FPG), rate of hypoglycaemia, weight, and adverse events. Results Most physicians initiated a basal analogue to improve glycaemic control (97%), with many delaying beginning treatment for several months (9 ± 9.0 months for general practitioners, 10.2 ± 16.2 months for specialists). Most patients continued oral anti‐diabetes drug therapy (95%) and lifestyle measures (92%), with 2–3 blood glucose readings per day and follow‐up telephone calls for dose optimization. Mean change in HbA 1c from baseline was − 1.3%, and − 3.1 mmol/L for fasting plasma glucose (both p < 0.0001). Hypoglycaemia increased from 1.4 to 5.6 events/patient/year ( p < 0.0001), and weight decreased on average by 0.5 kg with detemir, with no change in glargine. Most patients (93%) reported being satisfied or very satisfied with their insulin. Conclusions Insulin initiation with detemir or glargine can be successfully managed in both primary and secondary care; the benefits of basal analogues (once‐daily dosing, low rates of hypoglycaemia compared with neutral protamine Hagedorn) may have contributed to patient acceptance of the regimen. Copyright © 2012 John Wiley & Sons, Ltd.