The Use of Rescue Insulin in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).

Autor:	Hollander PA; Baylor Scott & White Research Institute, Dallas, TX., Krause-Steinrauf H; The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD., Butera NM; The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD., Kazemi EJ; The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD., Ahmann AJ; Oregon Health & Science University, Portland, OR., Fattaleh BN; VA Puget Sound Health Care System, Seattle, WA., Johnson ML; International Diabetes Center at Park Nicollet, Minneapolis, MN., Killean T; Southwestern American Indian Center, Phoenix, AZ., Lagari VS; Miami VA Healthcare System and University of Miami, Miami, FL., Larkin ME; Massachusetts General Hospital, Boston, MA., Legowski EA; The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD., Rasouli N; University of Colorado, School of Medicine, and VA Eastern Colorado Health Care System, Aurora, CO., Willis HJ; International Diabetes Center at Park Nicollet, Minneapolis, MN., Martin CL; University of Michigan, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2024 Apr 01; Vol. 47 (4), pp. 638-645.
DOI:	10.2337/dc23-0516
Abstrakt:	Objective: To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Research Design and Methods: GRADE participants (type 2 diabetes duration <10 years, baseline A1C 6.8%-8.5% on metformin monotherapy, N = 5,047) were randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin and followed quarterly for a mean of 5 years. Rescue insulin (glargine or aspart) was to be started within 6 weeks of A1C >7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey. Results: Nearly one-half of GRADE participants (N = 2,387 [47.3%]) met the threshold for rescue insulin. Among participants assigned to glimepiride, liraglutide, or sitagliptin, rescue glargine was added by 69% (39% within 6 weeks). Rescue aspart was added by 44% of glargine-assigned participants (19% within 6 weeks) and by 30% of non-glargine-assigned participants (14% within 6 weeks). Higher A1C values were associated with adding rescue insulin. Intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin were among the most common reasons reported for not adding rescue insulin within 6 weeks. Conclusions: Proportionately, rescue glargine, when required, was more often used than rescue aspart, and higher A1C values were associated with greater rescue insulin use. Wanting to use noninsulin strategies to improve glycemia was commonly reported, although multiple factors likely contributed to not using rescue insulin. These findings highlight the persistent challenge of intensifying type 2 diabetes treatment with insulin, even in a clinical trial. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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