The Diabetes Unmet Need with Basal Insulin Evaluation (DUNE) study in type 2 diabetes: Achieving HbA1c targets with basal insulin in a real-world setting
Por:
Meneghini, LF, Mauricio, D, Orsi, E, Lalic, NM, Cali, AMG, Westerbacka, J, Stella, P, Candelas, C, Pilorget, V, Perfetti, R, Khunti, K, DUNE Investigators
Publicada:
1 jun 2019
Resumen:
Aims To describe in a real-world setting the achievement of physician-selected individualized HbA1c targets in individuals with type 2 diabetes, newly or recently initiated with basal insulin, and the association of hypoglycaemia with target achievement. Materials and methods A 12-week, prospective, single-arm, observational study of adults with type 2 diabetes, either newly initiated with any basal insulin or start on basal insulin within the preceding 12 months. At enrollment, eligible participants from 28 countries were treated with or without oral antihyperglycaemic drugs and/or GLP-1 receptor agonists. Results Individualized targets for almost all of the 3139 evaluable participants (99.7%) had been set by their physicians, with 57% of participants having HbA1c targets between 7.0% and <7.5% (53 and <58 mmol/mol). By week 12, 28% and 27% of newly and previously initiated participants, respectively, achieved individualized HbA1c targets with modest average increases in daily insulin dose of 9 and 5 U (0.10 and 0.06 U/kg), respectively, from baseline (14 and 23 U [0.17 and 0.29 U/kg], respectively). Overall, 16% of participants experienced at least one episode of hypoglycaemia. Both the incidence and frequency of hypoglycaemia, but not the severity, were positively associated with a higher likelihood of achieving individualized HbA1c targets (P < 0.05). Conclusions In this prospective real-world study, most participants using basal insulin did not achieve the individualized HbA1c targets set by their physicians. Participants who experienced symptomatic hypoglycaemia were more likely to achieve HbA1c targets than those who did not.
Filiaciones:
Meneghini, LF:
Univ Texas Southwestern Med Ctr Dallas, Div Endocrinol, Dallas, TX 75390 USA
Parkland Hlth & Hosp Syst, Global Diabet Program, Dallas, TX USA
Mauricio, D:
Hosp Santa Creu & Sant Pau, CIBER Diabet & Associated Metab Dis, Dept Endocrinol & Nutr, Barcelona, Spain
Orsi, E:
Fdn Ca Granda IRCCS, Endocrine & Metab Dis Unit, Milan, Italy
Lalic, NM:
Univ Belgrade, Fac Med, Clin Ctr Serbia, Clin Endocrinol, Belgrade, Serbia
Cali, AMG:
Sanofi, Paris, France
Westerbacka, J:
Sanofi, Paris, France
Stella, P:
Sanofi, Paris, France
Candelas, C:
Sanofi, Chilly Mazarin, France
Pilorget, V:
Sanofi, Chilly Mazarin, France
Perfetti, R:
Sanofi, Bridgewater, NJ USA
Khunti, K:
Univ Leicester, Diabet Res Ctr, Leicester, Leics, England
Green Published, Hybrid Gold
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