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Title: Real-life glycemic control in patients with type 2 diabetes treated with insulin therapy: A prospective, longitudinal cohort study (Diabetes Distress and Care Registry at Tenri [DDCRT 9]).
Authors: Fujita, Naotaka
Yamamoto, Yosuke  kyouindb  KAKEN_id  orcid (unconfirmed)
Hayashino, Yasuaki
Kuwata, Hirohito
Okamura, Shintaro
Iburi, Tadao
Furuya, Miyuki
Kitatani, Masako
Yamazaki, Shin
Ishii, Hitoshi
Tsujii, Satoru
Inagaki, Nobuya  kyouindb  KAKEN_id
Fukuhara, Shunichi  kyouindb  KAKEN_id
Diabetes Distress and Care Registry at Tenri Study Group
Author's alias: 山本, 洋介
稲垣, 暢也
福原, 俊一
Keywords: Cohort study
Insulin therepy
Type 2 diabetes
Issue Date: 4-Mar-2018
Publisher: Wiley-Blackwell
Journal title: Journal of diabetes investigation
Volume: 9
Issue: 2
Start page: 294
End page: 302
Abstract: Aims/Introduction: We investigated the association between four insulin regimens, and increase in glycated hemoglobin (HbA1c) and insulin dose in a real‐life clinical setting because there are no data about them among insulin regimens. Materials and Methods: Participants included 757 patients with type 2 diabetes having been treated with insulin therapy for more than 1 year. The four insulin regimens were regimen 1 (long‐acting insulin, once daily), regimen 2 (biphasic insulin, twice daily), regimen 3 (biphasic insulin, three times daily) and regimen 4 (basal–bolus therapy). Main outcomes were increases in HbA1c levels >0.5% and increases in daily insulin units after 1 year. We carried out multivariable analyses to examine differences in glycemic control and insulin dose with adjustment for possible confounders. Results: Mean HbA1c level and duration of insulin therapy were 7.8% and 11.3 years, respectively. HbA1c levels increased by >0.5% at follow up in 22.8, 24.9, 20.7, and 29.3% of participants using regimen 1, 2, 3 and 4, respectively, with no significant differences between groups. Daily insulin doses increased in 62.3, 68.8, 65.3 and 38.6% of patients, respectively (P < 0.001). Multivariable regression analysis showed that patients who received regimen 4 had significantly lower odds of requiring future insulin dose increases than those who had received regimen 2 (adjusted odds ratio 0.24, 95% confidence interval 0.14–0.41; P < 0.001). Conclusions: Many patients receiving insulin therapy showed increases in HbA1c levels and insulin doses 1 year later. The smallest increase in insulin dose was observed in the basal–bolus therapy group compared with other regimens.
Rights: © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
DOI(Published Version): 10.1111/jdi.12693
PubMed ID: 28494126
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