title: Factors associated with reaching or not reaching target HbA1cafter initiation of basal or premixed insulin in patients with type 2 diabetes.
abstract: OBJECTIVE
  To evaluate factors associated with reaching or not reaching target glycated haemoglobin (HbA1c) levels by analysing the respective contributions of fasting hyperglycaemia (FHG), also referred to as basal hyperglycaemia, vs postprandial hyperglycaemia (PHG) before and after initiation of a basal or premixed insulin regimen in patients with type 2 diabetes.
  
  
  METHODS
  This post-hoc analysis of insulin-naïve patients in the DURABLE study randomised to receive either insulin glargine or insulin lispro mix 25 evaluated the percentages of patients achieving a target HbA1cof <7.0% (<53mmol/mol) per baseline HbA1cquartiles, and the effect of each insulin regimen on the relative contributions of PHG and FHG to overall hyperglycaemia.
  
  
  RESULTS
  Patients had comparable demographic characteristics and similar HbA1cand FHG values at baseline in each HbA1cquartile regardless of whether they reached the target HbA1c. The higher the HbA1cquartile, the greater was the decrease in HbA1c, but also the smaller the percentage of patients achieving the target HbA1c. HbA1cand FHG decreased more in patients reaching the target, resulting in significantly lower values at endpoint in all baseline HbA1cquartiles with either insulin treatment. Patients not achieving the target HbA1chad slightly higher insulin doses, but lower total hypoglycaemia rates.
  
  
  CONCLUSIONS
  Smaller decreases in FHG were associated with not reaching the target HbA1c, suggesting a need to increase basal or premixed insulin doses to achieve targeted fasting plasma glucose and improve patient response before introducing more intensive prandial insulin regimens.
authors.affiliation: University Hospital Center, University of Liège, 4000 Liège, Belgium. Electronic address: andre.scheen@chu.ulg.ac.be.
authors.forename: A J
authors.initials: AJ
authors.lastname: Scheen
authors.affiliation: Eli Lilly Benelux, 1000 Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Schmitt
authors.affiliation: Eli Lilly and Company, 46225 Indianapolis, IN, USA.
authors.forename: H H
authors.initials: HH
authors.lastname: Jiang
authors.affiliation: Lilly Hungary, 1075 Budapest, Hungary.
authors.forename: T
authors.initials: T
authors.lastname: Ivanyi
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D061268:Insulin Lispro / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D061268:Insulin Lispro
keywords: Basal insulin; HbA(1c) quartiles; Premixed insulin; Target HbA(1c); Type 2 diabetes