Abstract
The aim of A1chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced developed countries. To present results from the Bangladesh cohort of the A1chieve study receiving BIAsp 30 ± oral anti diabetic drugs. A1chieve was a 6-month, observational study of 66,726 people with type 2 diabetes, started on insulin detemir, insulin aspart or biphasic insulin aspart (BIAsp 30) in 28 countries across four continents. A total of 1,093 subjects were recruited from 49 sites in Bangladesh and 580 subjects initiated on BIAsp 30 were studied. In the entire cohort, treatment with BIAsp 30 for 24 weeks significantly reduced mean HbA(1c) (2.8%, p < 0.001), fasting plasma glucose (4.0 mmol/L, p < 0.001) and post prandial plasma glucose (6.6 mmol/L, p < 0.001) levels from baseline. The rate of overall hypoglycaemic events in the entire cohort also reduced significantly at 24 weeks (1.86 to 0.02 events/person year, p < 0.0001). BIAsp 30 can be considered as a safe and effective option for initiating as well as intensifying insulin therapy for type 2 diabetes.
Highlights
Current evidence-based guidelines from the International Diabetes Federation (IDF) suggest that insulin should be introduced when HbA1c value of ≤7.5% are not achieved by means of lifestyle modifications and with the use of two to three oral glucose lowering drugs (OGLDs)[1,2,3]
Earlier studies suggest that morbidity and mortality associated with hyperglycaemia can be reduced by controlling the postprandial plasma glucose (PPPG)[5,6]
Results from the DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) study which was carried out in more than 25,000 subjects, showed that any increase in PPPG levels led to significant increase in mortality regardless of the fasting plasma glucose (FPG) levels[5]
Summary
Current evidence-based guidelines from the International Diabetes Federation (IDF) suggest that insulin should be introduced when HbA1c value of ≤7.5% are not achieved by means of lifestyle modifications and with the use of two to three oral glucose lowering drugs (OGLDs)[1,2,3]. Postprandial glucose excursion is a wellrecognized contributor to daytime hyperglycaemia, past therapies for diabetes have been based primarily on fasting glucose measures. Earlier studies suggest that morbidity and mortality associated with hyperglycaemia can be reduced by controlling the postprandial plasma glucose (PPPG)[5,6]. Results from the DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) study which was carried out in more than 25,000 subjects (including 1275 previously diagnosed with diabetes), showed that any increase in PPPG levels led to significant increase in mortality regardless of the fasting plasma glucose (FPG) levels[5]. The importance of post prandial glucose (PPG) was reinforced by a study showing that glucose excursion after breakfast was a major contributor to failed glycaemic control in T2DM patients who were on OGLDs8
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