Clinical Outcomes of Switching to Insulin Glargine 300 U/ml from Other Basal Insulins in People with Type 2 Diabetes in Italy: A Real-World Study.

INTRODUCTION: Primary aim was to provide real-world evidence of the outcomes after the switch to glargine 300 U/ml (Gla-300) from other basal insulins (first or second generation) in Italy. METHODS: Multicenter, observational, retrospective study based on electronic medical records. RESULTS: Overall, 953 T2DM insulin ± OAD treated people switched to Gla-300 or Gla-100 from January 2015 to July 2018. Three clinically relevant cohorts were identified: patients switching to Gla-300 from first-generation basal insulin (cohort 1), patients switching to Gla-300 from degludec-100 (Deg-100) (cohort 2), and those switching to Gla-100 from any basal insulin (cohort 3). The three cohorts differed in terms of age, diabetes duration, and metabolic control. HbA1c changes after 6 months from the switch were - 0.27% (95% CI - 0.38; - 0.16), - 0.06% (95% CI - 0.31; 0.19), and - 0.30% (95% CI - 0.51; - 0.09) in the three cohorts, respectively. FPG significantly decreased in cohort 1 (- 14.07 mg/dl, 95% CI - 20.25; - 7.89), while body weight significantly decreased in cohort 2 (- 1.47 kg, 95% CI - 2.55; - 0.39). Doses of insulin marginally changed during the follow-up (+ 0.89 U in basal insulin daily dose in cohort 1 and + 2.07 U in short-acting insulin daily dose in cohort 2). CONCLUSIONS: Switching to Gla-300 from first-generation basal insulin in the real world is associated with improvements in metabolic control despite a suboptimal titration of both basal and short-acting insulins. Inertia in insulin titration documented in the Gla-100 cohort is also observed with the second-generation basal insulin. The switch to Gla-300 from Deg-100 was associated with a decrease in body weight of - 1.47 kg despite a slight increase in short-acting insulin daily doses of about + 2 U.

Cardiovascular risk factor control among diabetic patients attending community-based diabetic care clinics in Italy.

AIM OF THIS STUDY: To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in diabetic patients attending a network of urban community-based diabetic care clinics in Italy. METHODS: The study population included 1078 consecutive patients with type 2 diabetes mellitus (47% women, mean age 67.6+/-9.8 years) visited at eight diabetic care clinics between 1 and 30 of November 2004. Values of glycosilated hemoglobin, blood pressure, and cholesterol subfractions, as well as clinical and medication data, were prospectively collected in all cases in a computerized database. RESULTS: Despite a high prevalence of hypertension (66.6%), only 29.6% of patients met the treatment goal of a systolic blood pressure <130 mmHg, while a diastolic blood pressure <80 mmHg was reached by 38.6% of the study cohort. Optimal LDL cholesterol values (<100mg/dl) were present in just 25.5% of cases. Values of glycosilated hemoglobin <7% were present in 57.8% of patients. CONCLUSIONS: We conclude that adherence to current guidelines for cardiovascular prevention and cardiovascular risk factor control represent an exception in diabetic patients attending community-based diabetic care clinics. Major efforts are required to improve the quality of health care currently delivered to diabetic patients.