Indian Journal of Endocrinology and Metabolism

ORIGINAL ARTICLE
Year
: 2013  |  Volume : 17  |  Issue : 8  |  Page : 538--541

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


Sanjay Kalra1, Lokesh Garg2, Sandeep Suri3, Sameer Aggarwal4,  
1 Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
2 Santosh Hospital, Yamunanagar, Haryana, India
3 Holy Help Hospital, Hisar, Haryana, India
4 PGI, Rohtak, Haryana, India

Correspondence Address:
Sanjay Kalra
Bharti Research Institute of Diabetes and Endocrinology, Karnal
India

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 Haryana, India. Results: A total of 345 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 236), insulin detemir (n = 66), insulin aspart (n = 28), basal insulin plus insulin aspart (n = 1) and other insulin combinations (n = 14). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 10.7%) and insulin user (mean HbA 1 c: 10.5%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −3.9%, insulin users: −3.3%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.



How to cite this article:
Kalra S, Garg L, Suri S, Aggarwal S. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Haryana cohort of the A 1 chieve study.Indian J Endocr Metab 2013;17:538-541


How to cite this URL:
Kalra S, Garg L, Suri S, Aggarwal S. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Haryana cohort of the A 1 chieve study. Indian J Endocr Metab [serial online] 2013 [cited 2021 Jan 24 ];17:538-541
Available from: https://www.ijem.in/text.asp?2013/17/8/538/122122


Full Text

 Introduction



62.4 million Indians were reported to have type 2 diabetes mellitus (T2DM) putting India on the forefront of diabetic epidemic across globe. [1],[2] Fear of hypoglycaemia and gain in body weight are barriers for initiation of insulin therapy. [3] Modern insulin analogues are a convenient new approach or tool to glycaemic control, associated with low number of hypoglycaemia and favourable weight change. [4] 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. [5] This short communication presents the results for patients enrolled from Haryana, India.

 Materials and Methods



Please refer to editorial titled: The A1chieve study: Mapping the Ibn Battuta trail.

 Results



A total of 345 patients were enrolled in the study. The patient characteristics for the entire cohort divided as insulin-naïve and insulin users is shown in [Table 1]. Glycaemic control at baseline was poor in this population. The majority of patients (68.41%) started on or switched to biphasic insulin aspart. Other groups were insulin detemir (n = 66), insulin aspart (n = 28), basal insulin plus insulin aspart (n = 1) and other insulin combinations (n = 14).{Table 1}

After 24 weeks of treatment, overall hypoglycaemic events reduced from 1.1 events/patient-year to 0.1 events/patient-year in insulin naïve group and from 2.6 events/patient-year to 0.0 events/patient-year in insulin user group. The hypoglycaemia incidence in insulin naive group at 24 weeks was lower than that observed in insulin users at baseline. SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Blood pressure decreased in the total cohort, but the finding was limited by number of observations. Quality of life improved at 24 weeks [Table 2] and [Table 3].{Table 2}{Table 3}

All parameters of glycaemic control improved from baseline to study end in the total cohort [Table 4].{Table 4}

Biphasic insulin aspart ± OGLD

Of the total cohort, 236 patients started on biphasic insulin aspart ± OGLD, of which 197 (83.5%) were insulin naïve and 39 (16.5%) were insulin users. After 24 weeks of starting or switching to biphasic insulin aspart, hypoglycaemic events reduced from 0.6 events/patient-year to 0.0 events/patient-year in insulin naïve group and from 3.0 events/patient-year to 0.0 events/patient-year in insulin users group. Quality of life improved at the end of the study [Table 5] and [Table 6].{Table 5}{Table 6}

All parameters of glycaemic control improved from baseline to study end in those who started on or were switched to biphasic insulin aspart ± OGLD for both insulin naïve and insulin user groups [Table 7].{Table 7}

Basal + insulin aspart ± OGLD

Of the total cohort, only one patient was started on basal + insulin aspart ± OGLD.

Insulin detemir ± OGLD

Of the total cohort, 66 patients started on insulin detemir ± OGLD, of which 58 (87.9%) were insulin naïve and 08 (12.1%) were insulin users. After 24 weeks of starting or switching to biphasic insulin aspart, hypoglycaemic events reduced from 2.7 events/patient-year to 0.0 events/patient-year in insulin naïve group and from 1.6 events/patient-year to 0.0 events/patient-year in insulin users group. Body weight decreased and quality of life improved at 24 weeks [Table 8] and [Table 9].{Table 8}{Table 9}

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 10].{Table 10}

Insulin aspart ± OGLD

Of the total cohort, 28 patients started on insulin aspart ± OGLD, of which 26 (92.9%) were insulin naïve and 2 (7.1%) were insulin users. After 24 weeks of starting or switching to biphasic insulin aspart, hypoglycaemic events reduced from 1.0 events/patient-year to 0.0 events/patient-year in insulin naïve group whereas hypoglycaemia was nil in insulin users group similar to that of baseline. Quality of life improved at 24 weeks [Table 11] and [Table 12].{Table 11}{Table 12}

All parameters of glycaemic control improved from baseline to study end in those who started on or were switched to insulin aspart ± OGLDs for insulin naïve group [Table 13].{Table 13}

 Conclusion



Our study reports improved glycaemic control and quality of life following 24 weeks of treatment with any of the insulin analogues (Biphasic insulin aspart; insulin detemir; insulin aspart) with or without OGLD. A decrease in FPG and PPPG was noted for biphasic insulin aspart; insulin detemir; insulin aspart groups; this improvement was higher in insulin naïve compared to insulin users. A small weight reduction was noted for insulin detemir group only. SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. 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 Haryana, India.

References

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2Shetty P. Public health: India's diabetes time bomb. Nature 2012;485:S14-6.
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4Hirsch IB. Insulin analogues. N Engl J Med 2005;352:174-83.
5Shah 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.