Yonsei Med J.  2016 Nov;57(6):1395-1403. 10.3349/ymj.2016.57.6.1395.

Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes

• Kim G
• Lee YH
• Kang ES
• Cha BS
• Lee HC
• Lee BW

• KMID: 2427157
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1395

Abstract

PURPOSE
The objective of this study was to investigate clinical and laboratory parameters that could predict which patients could maintain adequate glycemic control after switching from initial insulin therapy to oral hypoglycemic agents (OHAs) among patients with type 2 diabetes (T2D).
MATERIALS AND METHODS
We recruited 275 patients with T2D who had been registered in 3 cohorts of initiated insulin therapy and followed up for 33 months. The participants were divided into 2 groups according to whether they switched from insulin to OHAs (Group I) or not (Group II), and Group I was further classified into 2 sub-groups: maintenance on OHAs (Group IA) or resumption of insulin (Group IB).
RESULTS
Of 275 patients with insulin initiation, 63% switched to OHAs (Group I) and 37% continued insulin (Group II). Of these, 44% were in Group IA and 19% in Group IB. The lowest tertile of baseline postprandial C-peptide-to-glucose ratio (PCGR), higher insulin dose at switching to OHAs, and higher HbA1c level at 6 months after switching to OHAs were all associated with OHA failure (Group IB; p=0.001, 0.046, and 0.014, respectively). The lowest tertile of PCGR was associated with ultimate use of insulin (Group IB and Group II; p=0.029).
CONCLUSION
Higher baseline level of PCGR and lower HbA1c levels at 6 months after switching to OHAs may be strong predictors for the successful maintenance of OHAs after switching from insulin therapy in Korean patients with T2D.

Keyword

Hypoglycemic agents; insulin; type 2 diabetes mellitus

MeSH Terms

Adult
Blood Glucose/*metabolism
C-Peptide
Diabetes Mellitus, Type 2/*drug therapy/metabolism/physiopathology
Drug Therapy, Combination
Female
Glycated Hemoglobin A/analysis/*metabolism
Humans
Hypoglycemic Agents/*administration & dosage/therapeutic use
Insulin/*administration & dosage/therapeutic use
Male
Middle Aged
Postprandial Period
Blood Glucose
C-Peptide
Glycated Hemoglobin A
Hypoglycemic Agents
Insulin

Figure

• 

  Fig. 1 Changes in regimen of subjects with type 2 diabetes. OHAs, oral hypoglycemic agents.

• 

  Fig. 2 HbA1c changes during the study periods. (A) HbA1c changes during the study periods according to groups. (B) HbA1c changes during the study periods between PCGR tertiles at baseline. (C) HbA1c changes during the study periods between PCGR tertiles among Group IA and IB. *p value <0.005, Group IA vs. Group IB, †p value <0.005, Group IA vs. Group II, ‡p value <0.005, PCGR in lowest tertile vs. PCGR in higher tertiles. PCGR, postprandial C-peptide-to-glucose ratio.

• 

  Fig. 3 Changes in HbA1c after switching to oral hypoglycemic agents (Group IA vs. Group IB). *p value <0.005, Group IA vs. Group IB, †HbA1c level at the same point of resumption with insulin in Group IB (at 9.2 months after switching to OHAs in Group IB and at 6–12 months after switching to OHAs in Group IA, respectively). OHA, oral hypoglycemic agent.

• 

  Fig. 4 Kaplan-Meier curves for events of resumption with insulin according to the tertiles of postprandial C-peptide-to-glucose ratio at baseline. PCGR, postprandial C-peptide-to-glucose ratio.

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