What can affect the effectiveness of basal insulin therapy for patients with type 2 diabetes mellitus: analysis of the results of real clinical practice according to the diabetes register

Background. For more than 20 years, the Federal Diabetes Register (FDR) has been functioning in Russia. It contains data unique in the number of patients and the time of observation. Currently, the FDR allows for a retrospective assessment of the quality of treatment of patients with different types of hypoglycemic therapy. In our observational program, the following question was studied: in which patients with type 2 diabetes mellitus (DM2), when and how is insulin therapy with basal insulin analogues initiated in real clinical practice, and what is the effectiveness of this therapy. Objective. Evaluation of the practice of initiating insulin therapy with glargine 100 U/ml followed by transfer to glargine 300 U/ml in DM2 patients, as well as the follow-up results of these patients. Methods. Based on the FDR, a sample of DM2 patients (n=200) with initiated insulin therapy with glargine 100 U/ml after 7 years from the start of treatment was formed. We assessed the parameters of carbohydrate metabolism (glycated hemoglobin [HbA1c] level and the proportion of patients with HbA1c level <7.0%), body mass index, blood pressure at the moment of the start of therapy, during 7 years of follow-up before the start of insulin therapy and 3 years after start of insulin therapy. Results. Quite low indicators of achieving glycemic control goals were demonstrated, begining from the start of hypoglicemic therapy at the time of diabetes mellitus detection (achievement of HbAc1 level <7.0% in less than 50% of patients), gradual loss of glycemic control after >3 years of follow-up after the start of hypoglicemic therapy (achievement HbAic level <7.0% in less than 35% of patients), and a low proportion of patients with HbAic level <7.0% after initiation of insulin therapy (less than 30.0%). Conclusion. 1) At all stages of treatment for DM2, including start of therapy, addition of the 2nd and 3rd oral antidiabetic drug to the treatment, initiation of insulin therapy, titration of the insulin dose, and clinical inertia impede the achievement of glycemic control goals. 2) Clinical inertia has a significant impact on the effectiveness of drugs (including insulin) in achieving glycemic control goals in real clinical practice.

glargin 100 U/ml, glargin 300 U/ml, Lantus, Toujeo, clinical inertia, insulin therapy, basal insulin analogue