Achievement of optimal glycaemic levels remains poor in the UK

Takeaway

• Between 2009 and 2013, an increasing number of patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM) in the United Kingdom required high insulin doses to control hyperglycaemia.
• Overall, achievement of optimal HbA1c levels remained poor.

Why this matters

• Early identification of patients requiring high-dose insulin initiation (HDII) can help plan alternative therapies and lifestyle strategies for achieving glycaemic control.

Study design

• Retrospective study used data from the Clinical Practice Research Datalink to evaluate 19,631 patients with T1DM or T2DM who were prescribed insulin between 2009 and 2013.
• Based on the total daily insulin dose patients were categorised into low-dose (≤200 units/day), high-dose (>200 units/day) and HDII (dose of >200 units/day during that year but a ≤200 units/day in the previous 6 months) groups.
• Funding: Eli Lilly and Company, Indianapolis, USA.

Key results

• Between 2009 and 2013, average weight (90.1 to 84.2 kg) and BMI (31.2 to 29 kg/m²) decreased in HDII group with T1DM.
• However, increasing BMI was associated with increasing risk for HDII in both T1DM (P<.001) and T2DM (P<.001).
• In 2013, 415 patients on HDII (T1DM, n=170; T2DM, n=245) were identified.
• More than half of patients on HDII with T1DM (56.4%) and T2DM (57.4%) continued to have HbA1c ≥8%.
• 94.1% and 83.7% patients of HDII group with T1DM and T2DM, respectively, were prescribed an insulin analogue.

Limitations

• Selection bias.
• Limited generalisability.