title: Glycemic response and attainment of A1C goals following newly initiated insulin therapy for type 2 diabetes.
abstract: OBJECTIVE
  To identify the characteristics associated with glycemic response to newly initiated insulin therapy.
  
  
  METHODS
  We identified 1,139 type 2 diabetic patients who initiated insulin therapy between 1 January 2009 and 30 June 2010. Outcomes of interest were the proportion of patients achieving A1C <7% and mean change in A1C within 3-9 months.
  
  
  RESULTS
  Mean A1C at insulin initiation was 8.2 vs. 9.2% among those who did and did not attain A1C <7% (P < 0.001). Within a mean of 5 months, 464 (40.7%) patients attained A1C <7%. In multivariable analyses controlling for insulin regimen, dose, and oral agent use, preinsulin A1C was responsible for nearly all the explained variance in A1C change. Each one percentage point of preinsulin A1C reduced the probability of attaining <7% by 26% (odds ratio 0.74 [95% CI 0.68-0.80]).
  
  
  CONCLUSIONS
  Insulin initiation at lower levels of A1C improves goal attainment and independently increases glycemic response.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon, USA. greg.nichols@kpchr.org
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kimes
authors.forename: Joyce B
authors.initials: JB
authors.lastname: Harp
authors.forename: Tzuyung Doug
authors.initials: TD
authors.lastname: Kou
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Brodovicz
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000196:embryology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin