title: Fasting plasma glucose 6-12 weeks after starting insulin glargine predicts likelihood of treatment success: a pooled analysis.
abstract: OBJECTIVE
  To evaluate whether fasting plasma glucose values measured early during insulin therapy can identify patients with Type 2 diabetes who may not achieve adequate glycaemic control after 6 months and will require additional treatment.
  
  
  METHODS
  Patient-level data from seven prospective, randomized, controlled studies using treat-to-target methods were pooled to evaluate the efficacy of insulin glargine. Fasting plasma glucose was measured at baseline, week 6 or 8 (6/8) and week 12. HbA(1c) was measured at week 24 to assess glycaemic control.
  
  
  RESULTS
  One thousand and thirty-six patients (56% male, 81% white) were included in the analysis (mean age 56.3 years; duration of diabetes 8.4 years). Baseline mean fasting plasma glucose was 11.2 mmol/l and mean HbA(1c) was 73 mmol/mol (8.8%). After 24 weeks of treatment, mean HbA(1c) decreased to 53 mmol/mol (7.0%); 56% of patients reached a target HbA(1c) ≤ 53 mmol/mol (7.0%). Significant correlations with week 24 HbA(1c) were obtained for fasting plasma glucose measured at week 6/8 and week 12 (r = 0.32; P < 0.0001 for both). Patients with fasting plasma glucose > 10 mmol/l at week 6/8 or week 12 were significantly less likely to achieve the HbA(1c) target at the end of treatment than patients with fasting plasma glucose < 8.9 mmol/l (P < 0.0001 for both). If fasting plasma glucose was > 10 mmol/l at week 6/8 or week 12, patients had only a 27% chance of reaching the HbA(1c) goal.
  
  
  CONCLUSIONS
  Fasting plasma glucose remaining > 10 mmol/l after 6-12 weeks of glargine therapy indicates that reaching target HbA(1c) ≤ 53 mmol/mol (7.0%) is unlikely and calls for individualized attention to consider further therapeutic options.
authors.affiliation: The Endocrine Clinic, Portland, OR 97216, USA. dkarl@pacifier.com
authors.forename: D
authors.initials: D
authors.lastname: Karl
authors.forename: R
authors.initials: R
authors.lastname: Zhou
authors.forename: A
authors.initials: A
authors.lastname: Vlajnic
authors.forename: M
authors.initials: M
authors.lastname: Riddle
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005215:Fasting / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008687:Metformin; C517652:hemoglobin A1c protein, human