Study of Once Daily Levemir (SOLVE): insights into the timing of insulin initiation in people with poorly controlled type 2 diabetes in routine clinical practice
Diabetes, Obesity and Metabolism, 06/04/2012
Khunti K et al. – Despite well–documented benefits of timely glycaemic control and consensus guidelines encouraging earlier use of insulin, considerable clinical inertia exists with respect to initiating appropriate insulin therapy in people with type 2 diabetes mellitus (T2DM). Considerable regional differences exist in the timing of insulin initiation and in the use of oral antidiabetic drugs (OADs).Methods
- Study of Once Daily Levemir was a 24-week international observational study involving 10 countries which evaluated the safety and effectiveness of initiating once-daily insulin detemir in people with type 2 diabetes mellitus (T2DM) being treated with one or more OADs.
- A total of 17 374 participants were enrolled in the study: aged 62 ± 12 years, 53% male, T2DM duration 10 ± 7 years, body mass index 29.3 ± 5.4 kg/m2.
- Pre-insulin HbA1c was 8.9 ± 1.6%.
- The proportion of patients with HbA1c ≥9.0% ranged from 64% (UK) to 23% (Poland).
- Pre-insulin OAD treatment included metformin (81%), sulphonylureas (59%), glinides (16%), thiazolidinediones (TZD) (12%), α-glucosidase inhibitors (12%) and dipeptidyl peptidase (DPP)-IV inhibitors (7%).
- The mean starting dose of insulin detemir for the total cohort was 0.16 ± 0.09 U/kg.
- Differences in OAD use and insulin doses at initiation were evident among participating countries.
- The largest proportional changes in OAD prescribing at insulin initiation were seen with glinides (+15%), sulphonylureas (-19%), TZD (-31%) and DPP-IV inhibitors (-28%).