• Media type: E-Article
  • Title: The Use of Rescue Insulin in the Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study (GRADE)
  • Contributor: Hollander, Priscilla A.; Krause-Steinrauf, Heidi; Butera, Nicole M.; Kazemi, Erin J.; Ahmann, Andrew J.; Fattaleh, Basma N.; Johnson, Mary L.; Killean, Tina; Lagari, Violet S.; Larkin, Mary E.; Legowski, Elizabeth A.; Rasouli, Neda; Willis, Holly J.; Martin, Catherine L.; Crandall, J.P.; McKee, M.D.; Behringer-Massera, S.; Brown-Friday, J.; Xhori, E.; Ballentine-Cargill, K.; Duran, S.; Estrella, H.; Gonzalez de la torre, S.; Lukin, J.; [...]
  • Published: American Diabetes Association, 2023
  • Published in: Diabetes Care
  • Extent:
  • Language: English
  • DOI: 10.2337/dc23-0516
  • ISSN: 0149-5992; 1935-5548
  • Keywords: Advanced and Specialized Nursing ; Endocrinology, Diabetes and Metabolism ; Internal Medicine
  • Abstract: <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study (GRADE).</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>GRADE participants (type 2 diabetes duration &amp;lt;10 years, baseline A1C 6.8%–8.5% on metformin monotherapy, N = 5,047) were randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin and followed quarterly for a mean of 5 years. Rescue insulin (glargine or aspart) was to be started within 6 weeks of A1C &amp;gt;7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Nearly one-half of GRADE participants (N = 2,387 [47.3%]) met the threshold for rescue insulin. Among participants assigned to glimepiride, liraglutide, or sitagliptin, rescue glargine was added by 69% (39% within 6 weeks). Rescue aspart was added by 44% of glargine-assigned participants (19% within 6 weeks) and by 30% of non-glargine-assigned participants (14% within 6 weeks). Higher A1C values were associated with adding rescue insulin. Intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin were among the most common reasons reported for not adding rescue insulin within 6 weeks.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Proportionately, rescue glargine, when required, was more often used than rescue aspart, and higher A1C values were associated with greater rescue insulin use. Wanting to use non-insulin strategies to improve glycemia was commonly reported, although multiple factors likely contributed to not using rescue insulin. These findings highlight the persistent challenge of intensifying type 2 diabetes treatment with insulin, even in a clinical trial.</jats:p> </jats:sec>
  • Description: <jats:sec>
    <jats:title>OBJECTIVE</jats:title>
    <jats:p>To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study (GRADE).</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>RESEARCH DESIGN AND METHODS</jats:title>
    <jats:p>GRADE participants (type 2 diabetes duration &amp;lt;10 years, baseline A1C 6.8%–8.5% on metformin monotherapy, N = 5,047) were randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin and followed quarterly for a mean of 5 years. Rescue insulin (glargine or aspart) was to be started within 6 weeks of A1C &amp;gt;7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey.</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>RESULTS</jats:title>
    <jats:p>Nearly one-half of GRADE participants (N = 2,387 [47.3%]) met the threshold for rescue insulin. Among participants assigned to glimepiride, liraglutide, or sitagliptin, rescue glargine was added by 69% (39% within 6 weeks). Rescue aspart was added by 44% of glargine-assigned participants (19% within 6 weeks) and by 30% of non-glargine-assigned participants (14% within 6 weeks). Higher A1C values were associated with adding rescue insulin. Intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin were among the most common reasons reported for not adding rescue insulin within 6 weeks.</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>CONCLUSIONS</jats:title>
    <jats:p>Proportionately, rescue glargine, when required, was more often used than rescue aspart, and higher A1C values were associated with greater rescue insulin use. Wanting to use non-insulin strategies to improve glycemia was commonly reported, although multiple factors likely contributed to not using rescue insulin. These findings highlight the persistent challenge of intensifying type 2 diabetes treatment with insulin, even in a clinical trial.</jats:p>
    </jats:sec>
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