A global study of the unmet need for glycemic control and predictor factors among patients with type 2 diabetes mellitus who have achieved optimal fasting plasma glucose control on basal insulin

作者：Raccah Denis^*; Chou Engels; Colagiuri Stephen; Gaal Zsolt; Lavalle Fernando; Mkrtumyan Ashot; Nikonova Elena; Tentolouris Nikolaos; Vidal Josep; Davies Melanie

来源：DIABETES-METABOLISM RESEARCH AND REVIEWS, 2017, 33(3): e2858.

DOI：10.1002/dmrr.2858

• fasting plasma glucose
• glycemic control
• insulin therapy
• postprandial glucose
• residual hyperglycemia
• type 2 diabetes mellitus

Background This study used data from different sources to identify the extent of the unmet need for postprandial glycemic control in patients with type 2 diabetes mellitus (T2DM) after the initiation of basal insulin therapy in Europe, Asia Pacific, the United States, and Latin America.
Methods Different levels of evidence were used as available for each country/region, with data extracted from seven randomized controlled trials (RCTs), three clinical trial registries (CTRs), and three electronic medical record (EMR) databases. Glycemic status was categorized as "well controlled" (glycated hemoglobin [HbA(1c)] at target [<7%]), "residual hyperglycemia" (fasting plasma glucose [FPG] but not HbA(1c) at target [FPG <7.2/7.8 mmol/L, < 130/140 mg/dL, depending on country-specific recommendations]), or "uncontrolled" (both FPG and HbA(1c) above target). Predictor factors were identified from the RCT data set using logistic regression analysis.
Results RCT data showed that 16.9% to 28.0%, 42.7% to 54.4%, and 16.9% to 38.1% of patients with T2DM had well-controlled glycemia, residual hyperglycemia, and uncontrolled hyperglycemia, respectively. In CTRs, respective ranges were 21.8% to 33.6%, 31.5% to 35.6%, and 30.7% to 46.8%, and in EMR databases were 4.4% to 21.0%, 23.9% to 31.8%, and 53.6% to 63.8%. Significant predictor factors of residual hyperglycemia identified from RCT data included high baseline HbA(1c) (all countries/regions except Brazil), high baseline FPG (United Kingdom/Japan), longer duration of diabetes (Brazil), and female sex (Europe/Latin America).
Conclusions Irrespective of intrinsic differences between data sources, 24% to 54% of patients with T2DM globally had residual hyperglycemia with HbA(1c) not at target, despite achieving FPG control, indicating a significant unmet need for postprandial glycemic control.

• 出版日期2017-3