title: Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations.
abstract: OBJECTIVE
  To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters.
  
  
  METHODS
  Study of Once-Daily Levemir (SOLVE(™) ) is an international, 24-week, observational study of insulin initiation in people with type 2 diabetes.
  
  
  RESULTS
  A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) -1.2 ± 1.4% (-13.1 ± 15.3 mmol/mol) and -1.3 ± 1.6% (-14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [-0.04%, 95% confidence interval (CI) -0.09 to -0.01 (-0.4 mmol/mol, 95% CI -1.0-0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06-0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64-0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001).
  
  
  CONCLUSIONS
  Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.
authors.affiliation: Department of Medicine, Cathedra of Family Medicine, University Miguel Hernandez, Alicante, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Orozco-Beltran
authors.affiliation: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
authors.forename: C
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Biostatistics, Novo Nordisk A/S, Søborg, Denmark.
authors.forename: A L
authors.initials: AL
authors.lastname: Svendsen
authors.affiliation: Department of Medical Affairs, Novo Nordisk A/S, Søborg, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Faerch
authors.affiliation: Servizio di Diabetologia, Policlinico Gemelli, Universita'Cattolica, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Caputo
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D000069057:Insulin Detemir / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir