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Year : 2012  |  Volume : 16  |  Issue : 8  |  Page : 432-433

Baseline results indicate poor glycemic control and delay in initiation and optimization of insulin therapy: results from the improving management practices and clinical outcomes in type 2 diabetes study

1 Institute of Diabetology, Madras Medical College, Chennai, India
2 Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, Aminjikarai, Chennai, India
3 Department of Medicine, Osmania Medical College, Ameerpet, Hyderabad, India
4 Diabetes Care and Research Centre, GCIB, Patna, India
5 Department of Diabetology, Government Rajaji Medical College, Madurai, India
6 Diabetes Care and Research Institute, Aminjikarai, Chennai, India
7 Bharti Hospital and B.R.I.D.E., Karnal, India
8 Novo Nordisk India Pvt. Ltd, Bangalore, Karnataka, India
9 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

Correspondence Address:
C R Anand Moses
Institute of Diabetology, 22, Casa Major Road, Egmore, Chennai - 600 008
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Source of Support: Unrestricted educational grant from novonordisk India Limited, Conflict of Interest: None

DOI: 10.4103/2230-8210.104120

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Introduction: Improving management practices and clinical outcomes in type 2 diabetes (IMPACT), was a prospective, open-label, 26- week, comparative, multi-center study to compare efficacy and safety of the Indian insulin guideline (IIG) group versus routine clinical practice (RCP) group in patients with type 2 diabetes. Materials and Methods: A total of 20,653 patients from 885 centers across India were enrolled and treated with premixed insulin therapy as per IIG or routine care. Results: Most of the participating centers (81.7%) reported following a diabetes guideline in their practice routinely but only 20.4% targeted HbA1c <7%. Very few of the physicians (2.7%) reported that most of their patients (>75%) achieved an HbA1c <7%. Most of the physicians (39.8%) also agreed that only 10-25% of the patients agree to start insulin therapy at the first counseling. Mean duration of diabetes before initiating insulin in patients using oral anti-diabetic drugs (OADs) was 7 years, indicating a delay in initiating insulin therapy. The difference in mean daily dose of insulin at initiation vs. at 26 weeks was only 0.8 U (25.8 ± 11.3 at initiation compared to 26.6 ± 9.5, respectively, p = ns) suggesting lack of treatment optimization. Weekly titration till achieving HbA1c <7% was done in 51.1% of the patients and only 8.9% performed self-titration. Conclusion: Baseline glycemic control in these patients was poor and reflects a delay in initiating insulin therapy. Data also reflect a lack of optimization of insulin doses.

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