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ORIGINAL ARTICLE
Year : 2013  |  Volume : 17  |  Issue : 8  |  Page : 477-481

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Abu Dhabi cohort of the A 1 chieve study


1 Department of Family Medicine, Advanced Pure Center, AUH, Abu Dhabi, United Arab Emirates
2 Department of Internal Medicine, Al Noor Hospital, AUH, Abu Dhabi, United Arab Emirates

Date of Web Publication27-Nov-2013

Correspondence Address:
Oula Alhabian
Advanced Pure Center AUH, Abu Dhabi
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.122085

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   Abstract 

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Abu Dhabi. Results: A total of 383 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 134), insulin detemir (n = 152), insulin aspart (n = 13), basal insulin plus insulin aspart (n = 42) and other insulin combinations (n = 41). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 9.4%) and insulin user (mean HbA 1 c: 9.1%) groups. After 24 weeks of treatment, both groups showed improvement in HbA 1 c (insulin naïve: −2.1%, insulin users: −1.8%). SADRs did not occur in any of the study patients. Major hypoglycaemic events remained same as that of baseline (0.1 events/patient-year) for insulin naïve group whereas major hypoglycaemia reduced from 0.1 events/patient-year to 0.0 events/patient-year in insulin users. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Keywords: A 1 chieve study, Abu Dhabi, insulin analogues, type 2 diabetes mellitus


How to cite this article:
Alhabian O, Yehyia M. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Abu Dhabi cohort of the A 1 chieve study. Indian J Endocr Metab 2013;17, Suppl S2:477-81

How to cite this URL:
Alhabian O, Yehyia M. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Abu Dhabi cohort of the A 1 chieve study. Indian J Endocr Metab [serial online] 2013 [cited 2019 Nov 15];17, Suppl S2:477-81. Available from: http://www.ijem.in/text.asp?2013/17/8/477/122085


   Introduction Top


The prevalence of diabetes in United Arab Emirates is estimated to be 12.6%, affecting 768 thousand people. [1] Fear of hypoglycaemia and gain in body weight are barriers for initiation of insulin therapy. [2] Modern insulin analogues are a convenient new approach or tool to glycaemic control, associated with low number of hypoglycaemia and favourable weight change. [3] A 1 chieve, a multinational, 24-week, non-interventional study, assessed the safety and effectiveness of insulin analogues in people with T2DM (n = 66,726) in routine clinical care. [4] This short communication presents the results for patients enrolled from Abu Dhabi.


   Materials and Methods Top


Please refer to editorial titled: The A 1 chieve study: Mapping the Ibn Battuta trail.


   Results Top


A total of 383 patients were enrolled in the study. The patient characteristics for the entire cohort divided as insulin-naïve and insulin users is shown in the [Table 1]. Glycaemic control at baseline was poor in this population. The majority of patients (39.7%) started on or switched to insulin detemir. Other groups were insulin aspart (n = 13), basal insulin plus insulin aspart (n = 42), Biphasic insulin aspart (n = 134) and other insulin combinations (n = 41).
Table 1: Overall demographic data

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After 24 weeks of treatment, overall hypoglycaemic events reduced from 2.0 events/patient-year to 0.2 events/patient-year in insulin user group whereas hypoglycaemia increased from 0.1 events/patient-year to 0.5 events/patient-year in insulin naive group. However, this hypoglycaemia incidence in insulin naive group at 24 weeks was still lower than that observed in insulin users at baseline. SADRs did not occur in any of the study patients. Major hypoglycaemic events remained same as that of baseline (0.1 events/patient-year) in insulin naïve group whereas it reduced from 0.1 events/patient-year to 0.0 events/patient-year in insulin users. Blood pressure decreased and overall lipid profile improved at week 24 in the cohort [Table 2] and [Table 3].
Table 2: Overall safety data

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Table 3: Insulin dose

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All parameters of glycaemic control improved from baseline to study end in the total cohort. More than one third of patients achieved HbA 1 c <7.0% at week 24 [Table 4].
Table 4: Overall efficacy data

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Biphasic insulin aspart ± OGLD

Of the total cohort, 134 patients started on biphasic insulin aspart ± OGLD, of which 84 (62.7%) were insulin naïve and 50 (37.3%) were insulin users. After 24 weeks of starting or switching to biphasic insulin aspart, hypoglycaemic events increased from 0.2 events/patient-year to 0.8 events/patient-year in insulin naïve group and from 0.5 events/patient-year to 0.6 events/patient-year in insulin users group. A small increase in body weight was also observed at the end of the study [Table 5] and [Table 6].
Table 5: Biphasic insulin aspart±oral glucose-lowering drug safety data

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Table 6: Insulin dose

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All parameters of glycaemic control improved from baseline to study end in those who started on or were switched to biphasic insulin aspart for both insulin naïve and insulin user groups [Table 7].
Table 7: Biphasic insulin aspart±oral glucose-lowering drug efficacy data

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Basal + insulin aspart ± OGLD

Of the total cohort, 42 patients started on basal + insulin aspart ± OGLD, of which 11 (26.2%) were insulin naïve and 31 (73.8%) were insulin users. After 24 weeks of starting or switching to basal + insulin aspart, hypoglycaemic events reduced from 4.6 events/patient-year to 0.0 events/patient-year in insulin user group whereas hypoglycaemia was nil similar to baseline in insulin naïve group. Body weight decreased at the end of the study [Table 8] and [Table 9].
Table 8: Basal+insulin aspart±oral glucose-lowering drug safety data

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Table 9: Insulin dose

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All parameters of glycaemic control improved from baseline to study end in those who started on or were switched to basal + insulin aspart ± OGLDs for both insulin naïve and insulin user groups [Table 10].
Table 10: Basal+insulin aspart±oral glucose-lowering drug efficacy data

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Insulin detemir ± OGLD

Of the total cohort, 152 patients started on insulin detemir ± OGLD, of which 99 (65.1%) were insulin naïve and 53 (34.9%) were insulin users. After 24 weeks of starting or switching to insulin detemir, hypoglycaemic events reduced from 2.7 events/patient-year to 0.0 events/patient-year in insulin user group, whereas hypoglycaemia increased from 0.0 events/patient-year to 0.3 events/patient-year in insulin naïve group. A decrease in body was also observed at 24 weeks [Table 11] and [Table 12].
Table 11: Insulin detemir±oral glucose-lowering drug safety data

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Table 12: Insulin dose

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All parameters of glycaemic control improved from baseline to study end in those who started on or were switched to insulin detemir ± OGLDs for both insulin-naïve and insulin user groups [Table 13].
Table 13: Insulin detemir±oral glucose-lowering drug efficacy data

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Insulin aspart ± OGLD

Of the total cohort, 13 patients started on insulin aspart ± OGLD, of which 5 (38.5%) were insulin naïve and 8 (61.5%) were insulin users. After 24 weeks of starting or switching to insulin aspart, hypoglycaemia was nil similar to that of baseline for both insulin naïve and insulin user groups. A decrease in body weight was observed in insulin naïve group [Table 14] and [Table 15].
Table 14: Insulin aspart±oral glucose-lowering drug safety data

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Table 15: Insulin dose

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Mean HbA 1 c and FPG values improved from baseline to study end in those who started on or were switched to insulin aspart ± OGLDs for both insulin naïve and insulin user groups [Table 16].
Table 16: Insulin aspart±oral glucose-lowering drug efficacy data

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   Conclusion Top


Our study reports improved glycaemic control following 24 weeks of treatment with any of the insulin analogues (Biphasic insulin aspart; basal + insulin aspart; insulin detemir; insulin aspart) with or without OGLD. SADRs did not occur in any of the study patients. Major hypoglycaemic events remained same as that of baseline (0.1 events/patient-year) in insulin naïve group whereas major hypoglycaemia reduced from 0.1 events/patient-year to 0.0 events/patient-year in insulin users. Overall, a small weight reduction was observed in insulin user group. Though the findings are limited by number of patients, still the trend indicates that insulin analogues can be considered effective and possess a safe profile for treating type 2 diabetes in Abu Dhabi.

 
   References Top

1.IDF Diabetes Atlas. 5 th ed. Available from: http://www.idf.org/atlasmap/atlasmap [Last accesed on 2013 Jun 10].  Back to cited text no. 1
    
2.Korytkowski M. When oral agents fail: Practical barriers to starting insulin. Int J Obes Relat Metab Disord 2002;26 Suppl 3:S18-24.  Back to cited text no. 2
    
3.Hirsch IB. Insulin analogues. N Engl J Med 2005;352:174-83.  Back to cited text no. 3
    
4.Shah SN, Litwak L, Haddad J, Chakkarwar PN, Hajjaji I. The A 1 chieve study: A 60 000-person, global, prospective, observational study of basal, meal-time, and biphasic insulin analogs in daily clinical practice. Diabetes Res Clin Pract 2010;88 Suppl 1:S11-6.  Back to cited text no. 4
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16]



 

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