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Aziz, F; Sternad, C; Sourij, C; Knoll, L; Kojzar, H; Schranz, A; Bürger, A; Sourij, H; Aberer, F.
Glycated haemoglobin, HOMA2-B, C-peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis.
Diabetes Obes Metab. 2024; 26(3):1082-1089 Doi: 10.1111/dom.15409
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Leading authors Med Uni Graz
Aziz Faisal
Sourij Harald
Co-authors Med Uni Graz
Aberer Felix
Knoll Lisa
Kojzar Harald
Sourij Caren
Sternad Christoph Peter
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Abstract:
AIM: Some people with type 2 diabetes mellitus (T2D) and declining β-cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2-B, C-peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. MATERIALS AND METHODS: In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53-69) years, diabetes duration 9 (5-15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non-insulin glucose-lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody-positive participants. The other clusters were distributed as mild age-related diabetes 33%; severe insulin-deficient diabetes 31%; mild obesity-related diabetes 20%; and severe insulin-resistant diabetes 15%. RESULTS: During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2-B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity-related diabetes [hazard ratio 3.28 (95% confidence interval 1.75-6.2)], followed by severe insulin-deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1-3.7)], mild age-related diabetes and the lowest for severe insulin-resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2-B (AUC 0.69) and CGR (AUC 0.64). CONCLUSION: HbA1c, indices of insulin secretion capacity (HOMA2-B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies.
Find related publications in this database (using NLM MeSH Indexing)
Female - administration & dosage
Humans - administration & dosage
Male - administration & dosage
Middle Aged - administration & dosage
Blood Glucose - metabolism
C-Peptide - administration & dosage
Diabetes Mellitus, Type 2 - complications, drug therapy, epidemiology
Glucose - administration & dosage
Glycated Hemoglobin - administration & dosage
Insulin - therapeutic use, metabolism
Insulin Resistance - physiology
Insulin, Regular, Human - administration & dosage
Obesity - complications
Prospective Studies - administration & dosage
Registries - administration & dosage
Aged - administration & dosage

Find related publications in this database (Keywords)
insulin therapy
glycaemic control
real-world evidence
type 2 diabetes
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