Insulin Glargine Combined with Oral Antidiabetic Drugs for Asians with Type 2 Diabetes Mellitus: A Pooled Analysis to Identify Predictors of Dose and Treatment Response

Tianwei Gu; Ting Hong; Pengzi Zhang; Sunyinyan Tang; Yan Bi; Hai Lu; Lichuang Men; Dongwei Ma; Dalong Zhu

doi:10.1007/s13300-018-0381-9

Insulin Glargine Combined with Oral Antidiabetic Drugs for Asians with Type 2 Diabetes Mellitus: A Pooled Analysis to Identify Predictors of Dose and Treatment Response

Diabetes Ther. 2018 Apr;9(2):771-787. doi: 10.1007/s13300-018-0381-9. Epub 2018 Mar 9.

Authors

Tianwei Gu¹, Ting Hong¹, Pengzi Zhang¹, Sunyinyan Tang¹, Yan Bi¹, Hai Lu², Lichuang Men², Dongwei Ma², Dalong Zhu³

Affiliations

¹ Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
² Sanofi Investment Co., Ltd., Shanghai, China.
³ Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China. zhudalong@nju.edu.cn.

Abstract

Introduction: In Asia, patients with type 2 diabetes mellitus (T2DM) often have suboptimal glycemic control for many years prior to initiating basal insulin. Active titration of basal insulin is also required to improve glycemic outcomes. This pooled analysis was conducted to determine the impact of patient baseline covariates on the required dose of basal insulin and treatment response, for the improved management of Asian patients with T2DM.

Methods: Data on insulin-naïve Asian patients with T2DM who initiated and fully titrated insulin glargine 100 U/mL (Gla-100) for ≥ 20 weeks were pooled from seven randomized, controlled, treat-to-target trials. Covariance and multivariate linear/logistic regression analyses were applied to determine the impact of the baseline covariates on Gla-100 dose (primary outcome) and treatment response (secondary outcomes) at week 24 for patients from Asia (N = 724) and from China alone (n = 249). Based on the multivariate analysis for the primary outcome in the Asian population, a nomogram was developed.

Results: The dose of Gla-100 at week 24 was negatively correlated with age and positively correlated with body mass index (BMI) and fasting plasma glucose (FPG) at baseline in both Asian and Chinese populations. In both populations, higher baseline glycated hemoglobin (HbA_1c) was associated with a lower reduction in HbA_1c from baseline, higher HbA_1c at week 24, and a lower chance of achieving HbA_1c < 7% at week 24. The constructed nomogram enables calculation of the likely dose of Gla-100 required by Asian patients with T2DM to achieve HbA_1c < 7% at week 24.

Conclusions: Higher doses of Gla-100 are likely to be required in younger patients or patients with higher baseline BMI or FPG. The nomogram developed in this study can aid clinicians to titrate the dose of Gla-100 appropriately. Evidence in this pooled analysis also indicates that initiating basal insulin at a lower HbA_1c can lead to greater glycemic control.

Funding: Sanofi China Investment Company.

Keywords: Asia; Basal insulin; China; Dose titration; Insulin glargine 100 U/mL; Nomogram; Pooled analysis; Type 2 diabetes mellitus.