The Use of Rescue Insulin in the Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study (GRADE)

Priscilla A. Hollander, Baylor Scott & White Research Institute, Dallas, TX.
Heidi Krause-Steinrauf, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Nicole M. Butera, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Erin J. Kazemi, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Andrew J. Ahmann, Oregon Health & Science University, Portland, OR.
Basma N. Fattaleh, VA Puget Sound Health Care System, Seattle, WA.
Mary L. Johnson, International Diabetes Center at Park Nicollet, Minneapolis, MN.
Tina Killean, Southwestern American Indian Center, Phoenix, AZ.
Violet S. Lagari, Miami VA Healthcare System and University of Miami, Miami, FL.
Mary E. Larkin, Massachusetts General Hospital, Boston, MA.
Elizabeth A. Legowski, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Neda Rasouli, University of Colorado, School of Medicine, and VA Eastern Colorado Health Care System, Aurora, CO.
Holly J. Willis, International Diabetes Center at Park Nicollet, Minneapolis, MN.
Catherine L. Martin, University of Michigan, Ann Arbor, MI.

Document Type

Journal Article

Publication Date

9-26-2023

Journal

Diabetes care

DOI

10.2337/dc23-0516

Abstract

OBJECTIVE: To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS: GRADE participants (type 2 diabetes duration <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 >7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey. RESULTS: 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. CONCLUSIONS: 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.

Department

Biostatistics and Bioinformatics

Link to Full Text

Share

COinS