Strategies for insulin initiation: insights from the French LIGHT observational study.
Fiche publication
Date publication
janvier 2012
Auteurs
Membres identifiés du Cancéropôle Est :
Pr VERGES Bruno
Tous les auteurs :
Verges B, Brun JM, Tawil C, Alexandre B, Kerlan V
Lien Pubmed
Résumé
BACKGROUND: The progressive nature of type 2 diabetes necessitates exogenous insulin use for most patients; basal insulin plus oral anti-diabetes drugs (OADs) is a well-validated way to facilitate insulin initiation. The primary aim of this study was to explore insulin initiation strategies and outcomes for patients using insulin detemir or glargine plus oral anti-diabetes drugs. METHODS: LIGHT was a 3-month, longitudinal observational study conducted across 761 French centres in insulin-naive type 2 diabetes patients managed under routine clinical care conditions, in either primary or secondary care. Endpoints included changes in HbA(1c) , fasting plasma glucose (FPG), rate of hypoglycaemia, weight, and adverse events. RESULTS: Most physicians initiated a basal analogue to improve glycaemic control (97%), with many delaying beginning treatment for several months (9 +/- 9.0 months for general practitioners, 10.2 +/- 16.2 months for specialists). Most patients continued oral anti-diabetes drug therapy (95%) and lifestyle measures (92%), with 2-3 blood glucose readings per day and follow-up telephone calls for dose optimization. Mean change in HbA(1c) from baseline was - 1.3%, and - 3.1 mmol/L for fasting plasma glucose (both p < 0.0001). Hypoglycaemia increased from 1.4 to 5.6 events/patient/year (p < 0.0001), and weight decreased on average by 0.5 kg with detemir, with no change in glargine. Most patients (93%) reported being satisfied or very satisfied with their insulin. CONCLUSIONS: Insulin initiation with detemir or glargine can be successfully managed in both primary and secondary care; the benefits of basal analogues (once-daily dosing, low rates of hypoglycaemia compared with neutral protamine Hagedorn) may have contributed to patient acceptance of the regimen.
Référence
Diabetes Metab Res Rev. 2012 Jan;28(1):97-105