PMID- 36799018
OWN - NLM
STAT- MEDLINE
DCOM- 20230504
LR  - 20230513
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 25
IP  - 6
DP  - 2023 Jun
TI  - Trajectory of glycated haemoglobin over time, using real-world data, in type 2 
      diabetes patients with obesity on a U-100 basal-bolus insulin regimen.
PG  - 1677-1687
LID - 10.1111/dom.15022 [doi]
AB  - AIMS: To identify patient clusters with poor glucose control among type 2 
      diabetes mellitus (T2DM) patients with obesity who are receiving basal-bolus 
      insulin and to identify the potential therapeutic inertia factors associated with 
      poor control. METHODS: Glycated haemoglobin (HbA1c) trajectories across a 3-year 
      period were structured at 6-month intervals for a retrospective cohort of T2DM 
      patients with obesity on basal-bolus insulin from the Veterans' Health 
      Administration database. Based on each patient's longitudinal HbA1c features, an 
      unsupervised clustering procedure was used to determine the numbers of clusters 
      and associated trajectory patterns. Multinomial logistic regression was used to 
      examine the association between HbA1c trajectory clusters and patient 
      characteristics/treatment patterns. RESULTS: A total of 51 273 patients were 
      included, of whom 11.2% were in a subgroup with persistent missingness of HbA1c 
      values. For those with sufficient HbA1c observations, cluster analysis indicated 
      six distinct HbA1c trajectories: stable low (35.8%); stable high (20.8%); 
      descending low (10.5%); ascending low (10.2%); descending high (5.7%); and 
      ascending high (5.7%). Being of Black ethnicity, not initiating noninsulin 
      antihyperglycaemic agents (sodium-glucose cotransporter-2 inhibitors, 
      glucagon-like peptide-1 receptor agonists or thiazolidinediones) or concentrated 
      insulin, low adherence (measured by proportion of days covered), and reduced 
      insulin prescription refills were factors associated with poorer HbA1c clusters; 
      similar factors were associated with persistent HbA1c missingness. CONCLUSION: 
      The present study found the potential for therapeutic inertia among a significant 
      proportion of T2DM patients with obesity on basal-bolus insulin. Subgrouping T2DM 
      patients based on HbA1c missingness and HbA1c trajectories can inform disease 
      management strategies.
CI  - (c) 2023 Eli Lilly & Company and The Authors. Diabetes, Obesity and Metabolism 
      published by John Wiley & Sons Ltd.
FAU - Chen, Jieling
AU  - Chen J
AD  - Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, 
      Indianapolis, Indiana, USA.
FAU - Fan, Ludi
AU  - Fan L
AD  - Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, 
      Indianapolis, Indiana, USA.
FAU - Maughn, Keisha
AU  - Maughn K
AD  - Real World Evidence, STATinMED Research, Plano, Texas, USA.
FAU - Rey, Gabriel G
AU  - Rey GG
AD  - Real World Evidence, STATinMED Research, Plano, Texas, USA.
FAU - Liu, Yi
AU  - Liu Y
AD  - Real World Evidence, STATinMED Research, Plano, Texas, USA.
FAU - Nelson, David R
AU  - Nelson DR
AD  - Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, 
      Indianapolis, Indiana, USA.
FAU - Hood, Robert C
AU  - Hood RC
AD  - Endocrine Clinic of Southeast Texas, Beaumont, Texas, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230323
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Glycated Hemoglobin)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Blood Glucose)
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy
MH  - Glycated Hemoglobin
MH  - Retrospective Studies
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin/therapeutic use
MH  - Obesity/complications/drug therapy
MH  - Blood Glucose
OTO - NOTNLM
OT  - database research
OT  - effectiveness
OT  - endocrine therapy
OT  - insulin therapy
OT  - type 2 diabetes
EDAT- 2023/02/18 06:00
MHDA- 2023/05/04 12:42
CRDT- 2023/02/17 02:53
PHST- 2023/02/08 00:00 [revised]
PHST- 2022/12/07 00:00 [received]
PHST- 2023/02/12 00:00 [accepted]
PHST- 2023/05/04 12:42 [medline]
PHST- 2023/02/18 06:00 [pubmed]
PHST- 2023/02/17 02:53 [entrez]
AID - 10.1111/dom.15022 [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2023 Jun;25(6):1677-1687. doi: 10.1111/dom.15022. Epub 2023 
      Mar 23.