title: Assessing achievement and maintenance of glycemic control by patients initiating basal insulin.
abstract: OBJECTIVE
  Describe characteristics of diabetic patients who initiated basal insulin and assess their glycemic control.
  
  
  METHODS
  Physician encounters in the General Electric EMR Database (2005-2010) were assessed for patients with type II diabetes (T2DM) who initiated basal insulin between February 2006 and August 2009, with initiation defined as no prescription record of insulin in prior 15 months. Patients were followed for an average 2.5 years after insulin initiation. The proportion and time to achieving HbA1c ≤ 7% ('goal') were assessed. Among patients who reached goal, the proportion and time to HbA1c increasing above 7% were analyzed. Cox proportional hazard models were estimated to identify predictors of HbA1c goal achievement and goal sustainability.
  
  
  RESULTS
  Basal insulin initiators with T2DM (n = 13,373) were on average 60 years old, 50.5% were females, and 59.5% had HbA1c > 8%; 5840 (44%) patients reached goal within one year and 7699 (58%) reached goal during the ∼2.5-year follow-up. Being older, white or male, lower baseline HbA1c values, and no OAD use before insulin initiation were associated with significantly higher rates of reaching goal. Among patients who reached goal, 57.6% could not sustain the goal. Being Hispanic, higher baseline HbA1c values, and baseline OAD use were associated with significantly lower rates of goal sustainment.
  
  
  CONCLUSIONS
  A high proportion of T2DM patients did not have adequate glycemic control after initiating basal insulin. Various factors existing prior to insulin initiation were related to successful treatment of T2DM. Further research on how to improve glycemic control is encouraged.
authors.affiliation: United BioSource Corporation, Lexington, MA, USA. ning.wu@unitedbiosource.com
authors.forename: Ning
authors.initials: N
authors.lastname: Wu
authors.forename: Mark
authors.initials: M
authors.lastname: Aagren
authors.forename: Luke
authors.initials: L
authors.lastname: Boulanger
authors.forename: Michelle
authors.initials: M
authors.lastname: Friedman
authors.forename: Kelly
authors.initials: K
authors.lastname: Wilkey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human