Status of basal-supported oral therapy in Chinese type 2 diabetic patients with inadequate glycemic control on oral anti-diabetic drugs.

Abstract

Timely initiation and titration of basal insulin added on to oral anti-diabetic drugs contribute to better glycemic control. However, implementation of basal-supported oral therapy in China is not yet clear. This nationwide, prospective, 12-week observational study was designed to explore the current status of basal-supported oral therapy in patients with type 2 diabetes in China. Type 2 diabetic patients with inadequate glycemic control on anti-diabetic drugs who were to start basal-supported oral therapy with insulin glargine at outpatient clinics were enrolled from 134 hospitals in China. Both the decision to initiate basal insulin and insulin dose adjustment were at the physician's discretion. Fasting plasma glucose (FPG) and haemoglobin A1c were measured, and the starting dose of insulin were recorded at baseline. Self-monitored fasting capillary blood glucose and the adjusting dose of insulin were collected during the study. A total of 11,192 out of 13,259 enrolled patients finished the 12-week study. FPG and haemoglobin A1c at basal-supported oral therapy initiation were 11.2 mmol/L and 9.4%, respectively, with insulin glargine started at 0.190 IU/kg/day. Insulin dose was increased 1.8 IU in average within 12 weeks. Fifty-nine percent of the patients achieved fasting capillary blood glucose ≤ 7.0 mmol/L. More patients achieved the glucose target in the group with lower baseline FPG level. Notable geographical differences of physicians' treatment habits in the current management of basal-supported oral therapy were also observed. A great gap between everyday clinical practice and guidelines exists in China, reflected by the delayed initiation, slow dose titration and geographical differences of basal-supported oral therapy management. A concrete guideline of basal-supported oral therapy management is needed in the clinical application.