Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes.
OBJECTIVE
The objective of this study was to investigate clinical and laboratory parameters that could predict which patients could maintain adequate glycemic control after switching from initial insulin therapy to oral hypoglycemic agents (OHAs) among patients with type 2 diabetes (T2D).


METHODS
We recruited 275 patients with T2D who had been registered in 3 cohorts of initiated insulin therapy and followed up for 33 months. The participants were divided into 2 groups according to whether they switched from insulin to OHAs (Group I) or not (Group II), and Group I was further classified into 2 sub-groups: maintenance on OHAs (Group IA) or resumption of insulin (Group IB).


RESULTS
Of 275 patients with insulin initiation, 63% switched to OHAs (Group I) and 37% continued insulin (Group II). Of these, 44% were in Group IA and 19% in Group IB. The lowest tertile of baseline postprandial C-peptide-to-glucose ratio (PCGR), higher insulin dose at switching to OHAs, and higher HbA1c level at 6 months after switching to OHAs were all associated with OHA failure (Group IB; p=0.001, 0.046, and 0.014, respectively). The lowest tertile of PCGR was associated with ultimate use of insulin (Group IB and Group II; p=0.029).


CONCLUSIONS
Higher baseline level of PCGR and lower HbA1c levels at 6 months after switching to OHAs may be strong predictors for the successful maintenance of OHAs after switching from insulin therapy in Korean patients with T2D.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Gyuri
G
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Yong Ho
YH
Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Eun Seok
ES
Kang
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Bong Soo
BS
Cha
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Hyun Chul
HC
Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Graduate School, Yonsei University College of Medicine, Seoul, Korea. bwanlee@yuhs.ac.
Byung Wan
BW
Lee
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
Hypoglycemic agents; insulin; type 2 diabetes mellitus