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Optimizing insulin initiation in primary care: the Diabetes CoStars patient support program

Authors Lutzko O, Schifferle H, Ariola M, Rich A, Meng-Kon K, Palmer H

Received 14 August 2015

Accepted for publication 23 November 2015

Published 28 January 2016 Volume 2016:7 Pages 3—10


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Olga K Lutzko,1 Helen Schifferle,2 Marita Ariola,3 Antonia Rich,4 Khen Meng Kon5

1Kardinia Health, GP Super Clinic, Belmont, VIC, 2Medicross Rothwell, Rothwell, QLD, 3Innerwest Specialist Centre, Burwood, NSW, Australia; 4Atlantis Healthcare Pty Ltd, Sydney, Australia; 5Sanofi Australia Pty Ltd, Macquarie Park, NSW, Australia

Purpose: The purpose of this study was to evaluate the optimization of fasting blood glucose (FBG) levels in patients with type 2 diabetes mellitus newly initiated on insulin glargine who were enrolled in the Australian Diabetes CoStars Patient Support Program (PSP).
Patients and methods: A retrospective analysis of data from 514 patients with type 2 diabetes mellitus who completed the 12-week Diabetes CoStars PSP was performed. All patients were initiated on insulin glargine in primary care and enrolled by their general practitioner, who selected a predefined titration plan and support from a local Credentialled Diabetes Educator. The data collected included initial and final insulin dose, self-reported FBG, and glycated hemoglobin (A1c) levels.
Results: The insulin dose increased in 81% of patients. Mean FBG was reduced from 208.8 mg/dL (11.6 mmol/L) to 136.8 mg/dL (7.6 mmol/L) after 12 weeks. Initial and final A1c values were available for 99 patients; mean A1c was reduced from 9.5% (80 mmol/mol) to 8.1% (65 mmol/mol). The reductions in mean FBG and A1c were similar irrespective of titration plan. Overall, 27.2% of patients achieved FBG levels within the titration plan target range of 72–108 mg/dL (4–6 mmol/L) and an additional 43.4% of patients achieved FBG within the range recommended by current Australian guidelines (110–144 mg/dL [6.1–8.0 mmol/L]). Overall, 23.3% of patients achieved the A1c target of ≤7%.
Conclusion: These data demonstrate that the majority of patients enrolled in the Diabetes CoStars PSP achieved acceptable FBG levels 12 weeks after starting insulin therapy irrespective of titration plan.

Keywords: insulin glargine, titration, type 2 diabetes mellitus, fasting blood glucose

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