Evaluation of insulin regimens as an effective option for glycemic control in patients with type 2 diabetes: A propensity score-matched cohort study across Japan (JDDM31).

Abstract

We evaluated the long-term efficacy of insulin regimens in patients with type 2 diabetes mellitus and poor glycemic control despite oral antidiabetic drugs (OAD). We carried out a propensity score-matched cohort study using the CoDiC(®) database of the Japan Diabetes Data Management Study Group across 54 institutions in Japan from 2005 to 2010. A total of 10,854 patients on OAD in 2005 were studied, and 1,253 patients (11.5%) were treated with insulin until 2010. The changes in insulin regimens and glycated hemoglobin (HbA1c) levels were analyzed over this study period. Propensity score matching showed no differences in the baseline patient characteristics. A total of 96 patients transferred to insulin, and HbA1c gradually and significantly decreased in the patients on a twice-daily premixed preparation of rapid-acting human-insulin analogs (twice-daily MIX) and basal-bolus therapy with rapid-acting human-insulin analogs (RA) plus long-acting insulin analog (LA; P<0.001). A total of 418 patients had insulin added to OAD treatment, and HbA1c decreased in the patients with a twice-daily MIX (P<0.001), but HbA1c did not differ from the baseline values in the patients on basal LA (P=0.497). The mean decline in HbA1c at the end of the study was therefore larger in the patients receiving twice-daily MIX than in the patients receiving basal LA (P<0.05). The present study could suggest the potential loss of opportunity for many patients treated using basal LA to have received alternative insulin regimens and to achieve better glycemic control.