title: Longitudinal change in HbA1c after insulin initiation in primary care patients with type 2 diabetes: a database analysis in UK and Germany.
abstract: OBJECTIVE
  To evaluate the 3-year change in HbA1c values after start of insulin therapy among patients with type 2 diabetes in primary care practices in UK and Germany.
  
  
  METHODS
  Longitudinal data from general practices in Germany and UK (Disease Analyser, IMS HEALTH) from 2005 to 2009 were analysed, including 779 patients (mean age±SD: 63±11yrs, HbA1c: 8.1±1.3%) in Germany and 646 patients (55±12yrs; 9.3±1.5%) in UK with first time insulin prescriptions in 2005 (index date). The mean individual relative changes in HbA1c over 3 years after index date were adjusted for age, sex, diabetes duration, oral antidiabetics, insulin type, comorbidity and visits using general linear models.
  
  
  RESULTS
  The average adjusted HbA1c improvements in the first 12 months in primary care patients were 0.5% (95%CI: 0.4-0.6%) in Germany and 1.0% (0.7-1.3%) in UK. Between 12 and 36 months these improvements in glycemic control were maintained in both patient groups.
  
  
  CONCLUSIONS
  Initiation of insulin therapy in primary care patients in Germany and UK was associated with a similar moderate improvement in glycemic control over the first 12 months. After this period, insulin therapy only maintained HbA1c values without additional improvement in glycemic control.
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf’m Hennekamp 65, Düsseldorf, Germany. rathmann@ddz.uni-duesseldorf.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Strassburger
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; C517652:hemoglobin A1c protein, human