Abstract
To investigate whether duration of diabetes has an impact on the effectiveness of insulinization in diabetes management. This open-label, noninterventional, observational registry was conducted at >500 centers in Korea. Patients with diabetes, on oral antidiabetic drugs, with HbA1c ≥7 % (53 mmol/mol) in the preceding 3 months, being considered for initiation of basal insulin by their physicians, were included. Data were collected at baseline and at 3 and 6 months. Of 6,616 patients evaluated, 62.5 % had diabetes for <10 years, while only 6.5 % patients had diabetes for ≥20 years. At the end of study, average HbA1c in patients with diabetes for <10 years, for 10 to <20 years, and for ≥20 years was 7.3 ± 1.0 % (56 ± 10.9 mmol/mol), 7.4 ± 1.0 % (57 ± 10.9 mmol/mol), and 7.6 ± 1.1 % (60 ± 12.0 mmol/mol), respectively. Over half the patients (50.7 %) with diabetes <10 years achieved HbA1c <7 % (53 mmol/mol) by the end of study, while only 42.1 and 35.1 % patients with diabetes for 10 to <20 and ≥20 years, respectively, achieved their target. The average insulin dosage required for per unit HbA1c reduction was significantly different among the groups according to duration of type 2 diabetes mellitus (p < 0.05). Among patients who achieved HbA1c <7 %, proportion of patients with hypoglycemia in the ≥20 years group was higher than that in the <10 years, 10 to <20 years groups. Early insulin administration provided a better glycemic control with less insulin dosage and lower frequency of hypoglycemic events. Thus, early insulinization might hold the key to better management of type 2 diabetes mellitus.
Similar content being viewed by others
References
Diabetes Atlas. http://www.idf.org. Accessed July 31 2013
Statistics Korea (2009) statistical results about cause of death. http://www.index.go.kr. Accessed July 31 2013
Type 2 diabetes: practical targets and treatments. http://www.idf.org/webdata/docs/T2D_practical_tt.pdf. Accessed 31 July 2013
Lim S, Kim DJ, Jeong IK et al (2009) A nationwide survey about the current status of glycemic control and complications in diabetic patients in 2006: the committee of the Korean diabetes association on the epidemiology of diabetes mellitus. Korean Diabetes J 33:48–57
Inzucchi SE, Bergenstal RM, Buse JB et al (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35:1364–1379
Jabbour S (2008) Primary care physicians and insulin initiation: multiple barriers, lack of knowledge or both? Int J Clin Pract 62:845–847
Riedel AA, Heien H, Wogen J, Plauschinat CA (2007) Secondary failure of glycemic control for patients adding thiazolidinedione or sulfonylurea therapy to a metformin regimen. Am J Manag Care 13:457–463
Riedel AA, Heien H, Wogen J, Plauschinat CA (2007) Loss of glycemic control in patients with type 2 diabetes mellitus who were receiving initial metformin, sulfonylurea, or thiazolidinedione monotherapy. Pharmacotherapy 27:1102–1110
Brown JB, Nichols GA, Perry A (2004) The burden of treatment failure in type 2 diabetes. Diabetes Care 27:1535–1540
Vinik A (2007) Advancing therapy in type 2 diabetes mellitus with early, comprehensive progression from oral agents to insulin therapy. Clin Ther 29:1236–1253
Swinnen SG, Hoekstra JB, DeVries JH (2009) Insulin therapy for type 2 diabetes. Diabetes Care 32(Suppl. 2):S253–S259
Tsai ST, Pathan F, Ji L et al (2011) First insulinization with basal insulin in patients with type 2 diabetes in a real-world setting in Asia. J Diabetes 3:208–216
Davies M, Storms F, Shutler S, Bianchi-Biscay M, Gomis R, ATLANTUS Study Group (2005) Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care 28:1282–1288
Riddle MC, Rosenstock J, Gerich J, Insulin Glargine 4002 Study Investigators (2003) The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 26:3080–3086
Dailey GE 3rd (2005) Early insulin: an important therapeutic strategy. Diabetes Care 28:220–221
Davidson MB (2005) Early insulin therapy for type 2 diabetic patients: more cost than benefit. Diabetes Care 28:222–224
Home PD, Boulton AJM, Jimenez J, Landgraf R, Osterbrink B, Christiansen JS (2003) Issues relating to the early or earlier use of insulin in type 2 diabetes. Pract Diabetes Int 20:63–71
Peyrot M, Rubin RR, Lauritzen T et al (2005) Resistance to insulin therapy among patients and providers: results of the cross-national diabetes attitudes, wishes, and needs (DAWN) study. Diabetes Care 28:2673–2679
ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR et al (2012) Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 367:319–328
Acknowledgments
Satyendra Shenoy, Anahita Gouri (India), and JeeHyun Lee (Korea) from Sanofi provided assistance of study process. This study was sponsored by Sanofi Korea Ltd.
Conflict of interest
Sang Soo Kim, In Joo Kim, Yong Ki Kim, Kun Ho Yoon, Ho Young Son, Sung Woo Park, Yeon Ah Sung, Hong Sun Baek, and Kyung Soo Ha declare that the study was sponsored by Sanofi Korea. Kyung Soo Ha is a Sanofi employee.
Human and animal rights
All procedures followed were in accordance with the ethical standards on human experimentation of the local ethics committees of every participating center and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent
Informed consent was obtained from all patients for which identifying information is included in this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
Communicated by Massimo Porta.
Rights and permissions
About this article
Cite this article
Kim, S.S., Kim, I.J., Kim, Y.K. et al. Duration of diabetes and effectiveness of insulin in the management of insulin-naïve Korean patients uncontrolled on oral antidiabetic drugs: a sub-analysis of the MOdaliTy of Insulin treatment eValuation (MOTIV) registry results. Acta Diabetol 51, 655–661 (2014). https://doi.org/10.1007/s00592-014-0572-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00592-014-0572-4