PMID- 36341227
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221108
IS  - 1178-7007 (Print)
IS  - 1178-7007 (Electronic)
IS  - 1178-7007 (Linking)
VI  - 15
DP  - 2022
TI  - Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? 
      Real-World Observation in China.
PG  - 3375-3385
LID - 10.2147/DMSO.S386230 [doi]
AB  - BACKGROUND: This study aims to compare the effectiveness of initiating insulin 
      therapy in inpatient and outpatient settings during a 6-month follow-up period 
      among patients with type 2 diabetes mellitus (T2DM) in real-world settings. 
      MATERIALS AND METHODS: The study was based on the ORBIT study, a real-world 
      observational study which recruited patients with inadequate glycemic control by 
      oral antidiabetic drugs (OAD) and initiated basal insulin (BI). We compare 
      difference in initiation and evolution of insulin therapy and glycemic control 
      after six months were compared between patients initiating basal insulin in the 
      inpatient department (inpatient initiators) and those starting in outpatient 
      (outpatient initiators) among participants without rehospitalization during the 
      six months follow-up. RESULTS: Among all 18,995 participants in the ORBIT study, 
      56.0% were inpatient initiators and 44.0% outpatient. We conducted in-depth 
      analysis among 14,860 patients without rehospitalization, 8129 inpatient 
      initiators and 6731 outpatient initiators. (1) Inpatient initiators had lower 
      insulin therapy persistence during six months (64.2%) than outpatient ones 
      (78.6%) (p<0.001), which was mainly explained by more therapy switches from 
      basal-bolus regimen to other therapies among inpatient initiators (50.1%) than 
      that among outpatient initiators (37.5%) (p<0.001). (2) Inpatient initiation had 
      a higher proportion of people achieving glucose targets (HbA1c <7%) than 
      outpatient initiation. However, the benefit of inpatient initiation versus 
      outpatient initiation was mainly observed among patients persisting with the 
      initial insulin therapies (46.3% vs 39.5% p<0.001), rather than those 
      nonpersistent (37.3% vs 36.2%, p=0.723). (3) Among patients with HbA1c <9%, 
      taking only one OAD and without complications at baseline, inpatient insulin 
      initiation did not show a higher proportion of people achieving glucose target 
      than outpatient initiation (adjusted odds ratio=0.96, 95% CI: 0.76-1.21). 
      CONCLUSION: For patients with HbA1c >/=9%, who were taking more than one OAD and 
      had complications at baseline, initiating insulin treatment during 
      hospitalization has a higher proportion of people achieving glucose target than 
      that in the outpatient department, but the premise is that the initial therapy is 
      acceptable and can be maintained after discharge. Patient-centered approach with 
      co-agreed decision-making to select a suitable insulin regimen should be 
      strengthened.
CI  - (c) 2022 Chen et al.
FAU - Chen, Minyuan
AU  - Chen M
AD  - The George Institute for Global Health, China, Beijing, 100600, People's Republic 
      of China.
FAU - Zhang, Puhong
AU  - Zhang P
AUID- ORCID: 0000-0003-4610-9848
AD  - The George Institute for Global Health, China, Beijing, 100600, People's Republic 
      of China.
AD  - The George Institute for Global Health, Faculty of Medicine, University of New 
      South Wales, Sydney, NSW, 2050, Australia.
FAU - Zhao, Yang
AU  - Zhao Y
AD  - The George Institute for Global Health, China, Beijing, 100600, People's Republic 
      of China.
AD  - WHO Collaborating Centre on Implementation Research for Prevention and Control of 
      Noncommunicable Diseases, Melbourne, VIC, Australia.
FAU - Duolikun, Nadila
AU  - Duolikun N
AD  - The George Institute for Global Health, China, Beijing, 100600, People's Republic 
      of China.
FAU - Ji, Linong
AU  - Ji L
AD  - Department of Endocrinology and Metabolism, Peking University People's Hospital, 
      Beijing, People's Republic of China.
LA  - eng
PT  - Journal Article
DEP - 20221031
PL  - New Zealand
TA  - Diabetes Metab Syndr Obes
JT  - Diabetes, metabolic syndrome and obesity : targets and therapy
JID - 101515585
PMC - PMC9635311
OTO - NOTNLM
OT  - BI
OT  - T2DM
OT  - basal insulin
OT  - glycemic control
OT  - hospitalization
OT  - outpatient
OT  - type 2 diabetes mellitus
COIS- L. J. reported receiving consulting and lecture fees from Eli Lilly, 
      Bristol-Myers Squibb, Novartis, Novo Nordisk, Merck, Bayer, Takeda, Sanofi, Roche 
      and Boehringer Ingelheim, and research grants from Roche and Sanofi. The other 
      authors declare that they have no conflicts of interest.
EDAT- 2022/11/08 06:00
MHDA- 2022/11/08 06:01
PMCR- 2022/10/31
CRDT- 2022/11/07 05:13
PHST- 2022/08/15 00:00 [received]
PHST- 2022/10/18 00:00 [accepted]
PHST- 2022/11/07 05:13 [entrez]
PHST- 2022/11/08 06:00 [pubmed]
PHST- 2022/11/08 06:01 [medline]
PHST- 2022/10/31 00:00 [pmc-release]
AID - 386230 [pii]
AID - 10.2147/DMSO.S386230 [doi]
PST - epublish
SO  - Diabetes Metab Syndr Obes. 2022 Oct 31;15:3375-3385. doi: 10.2147/DMSO.S386230. 
      eCollection 2022.