Identifying patients with type 2 diabetes in which basal supported oral therapy may not be the optimal treatment strategy.
BACKGROUND
Basal insulin supported oral therapy (BOT) can greatly improve glycaemic control; however, it may not be an optimal treatment for every patient. The identification of patient-related characteristics that may predict a switch of the treatment strategy away from BOT after originally initiating it, would be useful when deciding on treatment strategies clinically.


METHODS
Data from the German DIabetes Versorgungs-Evaluation (DIVE) registry were analysed for patients treated with BOT for at least 3months. BOT discontinuation was defined as the cessation of oral therapy, of insulin therapy, or the addition of short-acting insulin. Risk quantification for demographics, glycaemic control, and treatment characteristics of patients were based on Cox proportional hazards regression.


RESULTS
BOT discontinuation occurred in 2021 patients (35.7%) of the 5663 that fulfilled the inclusion criteria for the study. Of these, 46.7% discontinued oral therapy, 32.7% discontinued insulin, and 20.6% had short-acting insulin added to their treatment. Multivariate analysis revealed that higher body mass index (BMI; hazard ratio, HR: 1.012; 95% CI: 1.001-1.023; p=0.029), shorter diabetes duration (HR: 0.982; 95% CI: 0.976-0.989; p<0.001), and higher HbA1c level (HR: 1.102; 95% CI: 1.022-1.188; p=0.011) were associated with BOT discontinuation.


CONCLUSIONS
Identification of factors that may be predictive of a discontinuation of BOT could be highly useful in a clinical setting when assessing the most appropriate treatment strategy for type 2 diabetes patients.
Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany. Electronic address: peter.bramlage@ippmed.de.
Peter
P
Bramlage
Institut für Statistik, Universität Ulm, Ulm, Germany. Electronic address: tobias.bluhmki@uni-ulm.de.
Tobias
T
Bluhmki
Institut für Biometrie und Epidemiologie, Deutsches Diabetes Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine Universität, Düsseldorf, Germany. Electronic address: rathmann@ddz.uni-duesseldorf.de.
Wolfgang
W
Rathmann
Gemeinschaftspraxis Kaltheuner - v. Boxberg, Leverkusen, Germany; winDiab GmbH, Düsseldorf, Germany. Electronic address: m.kaltheuner@web.de.
Matthias
M
Kaltheuner
Institut für Statistik, Universität Ulm, Ulm, Germany.
Jan
J
Beyersmann
winDiab GmbH, Düsseldorf, Germany; Kinder- und Jugendkrankenhaus "AUF DER BULT", Hannover, Germany. Electronic address: danne@hka.de.
Thomas
T
Danne
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
Basal; Cox proportional hazards model; Glycaemic control; Insulin; Oral antidiabetic drugs