Abstract
Insulin therapy is frequently required to achieve glycemic targets (A1c) in type 2 diabetes (T2D); however, clinicians and patients face barriers with the complexities of multiple daily injection regimens. Patch-like wearable insulin devices, such as V-Go, may simplify and optimize this complexity. This study evaluated the change in A1C and insulin total daily dose (TDD) in a suboptimally-controlled (not achieving A1C targets) T2D population after switching to V-Go. A retrospective chart analysis at a diabetes clinic was performed to evaluate change in A1c measurements from baseline (V-Go initiation) to end of study observation. Of the 139 patients enrolled, A1C significantly decreased from baseline (−1.5 ± 1.79%; p < 0.001). Patients prescribed insulin at baseline (n = 122) used significantly less insulin TDD (−8 u/day; p = 0.006). The percentage of patients meeting the target of A1C < 8% increased from 14% at baseline to 48% at study completion (p = 0.008). Patients prescribed a basal-bolus regimen prior to V-Go achieved an A1C reduction of 1.5 ± 2.0% (p < 0.0001) and experienced the greatest reduction in TDD (−24 u/day; p < 0.0001). Thus, patients switching to V-Go from a variety of therapies at baseline experienced reductions in A1C while using less insulin, with a reduction in clinically relevant hypoglycemia, indicating the potential benefit of V-Go in optimizing and simplifying T2D care.
Highlights
IntroductionImproving glycemic control has been shown to reduce diabetes-related complications; even a 1%
Diabetes is a chronic and complex disease that affects more than 34 million Americans [1].Improving glycemic control has been shown to reduce diabetes-related complications; even a 1%reduction in hemoglobin A1C (A1C) has been associated with reductions in diabetes-related deaths, microvascular complications and myocardial infarction [2]
Suggests less stringent glycemic goals (A1C < 8%) are appropriate in patients with advanced or long-standing disease, at risk for hypoglycemia, and in those preferring a less burdensome therapy [25]. This retrospective analysis of 139 patients with type 2 diabetes switched from prior anti-hyperglycemic therapy to basal-bolus insulin therapy with V-Go showed a significant and clinically relevant 1.52% reduction in A1C using a lower total daily dose (TDD) of insulin after a mean of 5 months of therapy
Summary
Improving glycemic control has been shown to reduce diabetes-related complications; even a 1%. Reduction in hemoglobin A1C (A1C) has been associated with reductions in diabetes-related deaths, microvascular complications and myocardial infarction [2]. Assurance (NCQA), is commonly used as a performance improvement tool and includes proportion of patients meeting A1C thresholds as a performance indicator for diabetes. The HEDIS reports poor glycemic control as A1C > 9%; and glycemic control as A1C < 8.0% and < 7.0% in select populations [3]. These target thresholds are consistent with the American Diabetes Association (ADA) recommendation that a target of A1C < 7% is appropriate for many patients. A target of
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