నైరూప్య

Low rate of intensification in type 2 diabetic patients inadequately controlled with basal insulin: the INTERDIA study

Roussel R, Gourdy P, Gautier JF, Guerci B, Raccah D, Behar M, Robert J & Detournay B

To estimate the delay before treatment intensification in poorly controlled basal insulintreated patients with type 2 diabetes mellitus (T2DM), with or without oral antidiabetic drugs (OAD) but no Glucagon-Like Peptide-1 receptor agonist (GLP-1-RA). Methods: A retrospective analysis of prescribing records of a sample of general practitioners was conducted. Inadequate glycaemic control in T2DM was defined by two successive HbA1c values over 7% (scenario 1) or 8% (scenario 2) at least 3 months apart. Treatment intensification was defined either by a change in drug regimen (either the addition of a non-basal insulin, GLP-1-RA or any OAD), or by increasing the dose of basal insulin by at least 10% when represcribing. Cumulated insulin dose increase over the observation period by at least 20% was also tested. The delay to intensification was calculated from the first HbA1c value higher than 7% or 8%, respectively. Results: Two populations with documented poorly controlled diabetes consisting of 500 patients in Scenario 1 and 684 in Scenario 2 were selected. After one year, treatment was intensified (modification of drug regimen) in 16.3% [95% CI: 12.2%, 21.8%] of patients in scenario 1 and 24.0% [17.3%, 32.7%] in scenario 2. Including insulin dose increase of at least 10%, this proportion was increased to 55.5% [49.5%; 61.7%] and 66.1% [57.6%, 74.5%], respectively. Conclusion: Lack of intensification remains high in patients with poorly controlled T2DM treated with basal insulin. Further investigations are needed to understand whether it is related to therapeutic inertia, or to very loose objectives, or both.