PMID- 21834876
OWN - NLM
STAT- MEDLINE
DCOM- 20120224
LR  - 20221207
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 14
IP  - 1
DP  - 2012 Jan
TI  - The economic and clinical benefits of adequate insulin initiation and 
      intensification in people with type 2 diabetes mellitus.
PG  - 47-57
LID - 10.1111/j.1463-1326.2011.01487.x [doi]
AB  - AIM: To study the clinical and economic benefits associated with adequate and 
      early initiation and intensification of insulin in people with type 2 diabetes 
      mellitus (T2DM). METHODS: A systematic review was performed using published 
      articles from January 2000 to August 2010 that linked intervention, disease, 
      study design and outcomes. Studies were further classified as initiation and 
      intensification based on predefined criteria. Individual studies in systematic 
      reviews and meta-analysis were searched and included if relevant. RESULTS: A 
      total of 2690 articles were screened with 76 (40 initiation and 36 
      intensification) studies included. Most initiation studies had mean baseline 
      HbA1c values of >8.5%. The endpoint HbA1c values were reduced with insulin 
      treatment in these studies, with endpoint values ranging from 6.6 to 9.8%. 
      Similar results were seen with the intensification studies (endpoint HbA1c: 
      6.4-9.6%). Addition of insulin to oral antidiabetics (OADs) resulted in better 
      glycaemic control in most studies. Blood glucose levels reduced substantially 
      with OADs + insulin compared with OADs alone. Quality of life outcomes and 
      treatment satisfaction were reported in six studies and not significantly 
      different for insulin vs. OADs. Hypoglycaemic events were manageable with insulin 
      initiation. However, all insulin types were associated with weight gain although 
      the comparison with OADs elicited varying results. CONCLUSIONS: Proactive 
      management with early insulin initiation and intensification should be considered 
      in people with T2DM in inadequate glycaemic control. The economic benefits with 
      early initiation and intensification have to be fully explored.
CI  - (c) 2011 Blackwell Publishing Ltd.
FAU - Asche, C V
AU  - Asche CV
AD  - Centre for Health Outcomes Research, Department of Medicine, University of 
      Illinois College of Medicine, Peoria, IL 61656-1649, USA. cva@uicomp.uic.edu
FAU - Bode, B
AU  - Bode B
FAU - Busk, A K
AU  - Busk AK
FAU - Nair, S R
AU  - Nair SR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20111122
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Administration, Oral
MH  - Blood Glucose/*drug effects
MH  - Cost-Benefit Analysis
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy/economics
MH  - Drug Administration Schedule
MH  - Evidence-Based Medicine
MH  - Glycated Hemoglobin/*drug effects
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage/economics/*therapeutic use
MH  - Insulin/analogs & derivatives/economics/*therapeutic use
MH  - Quality of Life
MH  - Randomized Controlled Trials as Topic
MH  - Weight Gain
EDAT- 2011/08/13 06:00
MHDA- 2012/03/01 06:00
CRDT- 2011/08/13 06:00
PHST- 2011/08/13 06:00 [entrez]
PHST- 2011/08/13 06:00 [pubmed]
PHST- 2012/03/01 06:00 [medline]
AID - 10.1111/j.1463-1326.2011.01487.x [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2012 Jan;14(1):47-57. doi: 10.1111/j.1463-1326.2011.01487.x. 
      Epub 2011 Nov 22.