title: Baseline results indicate poor glycemic control and delay in initiation and optimization of insulin therapy: results from the improving management practices and clinical outcomes in type 2 diabetes study.
abstract: BACKGROUND
  Improving management practices and clinical outcomes in type 2 diabetes (IMPACT), was a prospective, open-label, 26- week, comparative, multi-center study to compare efficacy and safety of the Indian insulin guideline (IIG) group versus routine clinical practice (RCP) group in patients with type 2 diabetes.
  
  
  METHODS
  A total of 20,653 patients from 885 centers across India were enrolled and treated with premixed insulin therapy as per IIG or routine care.
  
  
  RESULTS
  Most of the participating centers (81.7%) reported following a diabetes guideline in their practice routinely but only 20.4% targeted HbA1c <7%. Very few of the physicians (2.7%) reported that most of their patients (>75%) achieved an HbA1c <7%. Most of the physicians (39.8%) also agreed that only 10-25% of the patients agree to start insulin therapy at the first counseling. Mean duration of diabetes before initiating insulin in patients using oral anti-diabetic drugs (OADs) was 7 years, indicating a delay in initiating insulin therapy. The difference in mean daily dose of insulin at initiation vs. at 26 weeks was only 0.8 U (25.8 ± 11.3 at initiation compared to 26.6 ± 9.5, respectively, p = ns) suggesting lack of treatment optimization. Weekly titration till achieving HbA1c <7% was done in 51.1% of the patients and only 8.9% performed self-titration.
  
  
  CONCLUSIONS
  Baseline glycemic control in these patients was poor and reflects a delay in initiating insulin therapy. Data also reflect a lack of optimization of insulin doses.
authors.affiliation: Institute of Diabetology, Madras Medical College, Chennai, India.
authors.forename: C R Anand
authors.initials: CR
authors.lastname: Moses
authors.forename: V
authors.initials: V
authors.lastname: Seshiah
authors.forename: B K
authors.initials: BK
authors.lastname: Sahay
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: A J
authors.initials: AJ
authors.lastname: Asirvatham
authors.forename: V
authors.initials: V
authors.lastname: Balaji
authors.forename: S
authors.initials: S
authors.lastname: Kalra
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.forename: R
authors.initials: R
authors.lastname: Shetty
authors.forename: A K
authors.initials: AK
authors.lastname: Das
keywords: IMPACT; baseline glycemic control; insulin dose optimisation
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