title: Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System.
abstract: To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy.
  
  
  
  The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion criteria were: age ≥ 40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤ 53 mmol/mol (7%) with oral glucose-lowering agents; and a follow up ≥ 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA1c . Subjects considered to be 'off target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during one-third or more of the follow-up time, and those considered to be 'on target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during less than one-third of the follow-up time.
  
  
  
  Four HbA1c trajectories were identified. Most people (88.7%) were classified as having a stable HbA1c trajectory of ~57 mmol/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA1c levels and a higher age at the start of insulin treatment.
  
  
  
  Using latent class growth modelling, four HbA1c trajectories were identified. A quarter of the people starting insulin were on target. Low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Mast
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.|Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Walraven
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.|Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Hoekstra
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.
authors.forename: A P D
authors.initials: AP
authors.lastname: Jansen
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.
authors.forename: A A W A
authors.initials: AA
authors.lastname: van der Heijden
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.
authors.forename: P J M
authors.initials: PJ
authors.lastname: Elders
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Dekker
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.|Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Hugtenburg
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D008076:Cholesterol, HDL / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D014280:Triglycerides / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D014280:Triglycerides