19-LB: Treatment Intensification and Risk of Cardiovascular Events in Insulin-Treated Patients with Type 2 Diabetes: A United Kingdom Retrospective Cohort Study
Authors: ADAN MUNA , SEIDU SAMUEL , KHUNTI KAMLESH , ZACCARDI FRANCESCO , GILLIES CLARE L. , LUBWAMA ROBERT , BOSS ANDERS H. , DEX TERRY A. 
Published: June 2020

Using the Clinical Practice Research Datalink, adults diagnosed with T2DM newly initiated with a basal long/intermediate-acting insulin from January 2004 to December 2016 were identified. First change or add on of short or premix insulin and/or OADs was defined as intensification. Patients were categorized into three groups; uncontrolled glycaemia at baseline (≥7% HbA1c) and early (within 1-year) intensifiers, and uncontrolled glycaemia at baseline and delayed (&gt;1-year) intensifiers and uncontrolled-non-intensifiers as a reference groups. A total of n=8,538 patients were included; 32.95% (n=2,813) were uncontrolled-glycaemic-early intensifiers, 28.91% (n=2,468) were uncontrolled glycaemic-delayed intensifiers, and 38.15% (n=3,257) were non-intensifiers. Majority of the early and delayed intensified patients were males (54.60% and 57.41% respectively) and the average age was 62.40years. Non-intensifiers were older (67.72 years) and had a greater number of risk factors. Median baseline HbA1c was 85.90mmol/mol [10.01%] (IQR, 73.9-101.0 mmol/mol; 8.91-11.39%) and 82.50mmol/mol [9.70%] (IQR, 71.60-96.70mmol/mol, 8.70-11.00%) in the early and delayed treatment intensified group respectively. Early treatment intensification within 1-year post basal insulin therapy was linked to 18% (HR CI: 0.65, 1.03), 23% (HR CI: 0.58, 1.02) and 28% (HR CI: 0.58, 0.93) reduction in the risk of HF, MI and stroke respectively. CVE risk was also reduced in the delayed versus non-intensified group.

In conclusion, large proportion of patients remain non-intensified post basal insulin despite poor glycemic control, timely intensification in primary care is thus central in minimising CVE complications.

Disclosure

M. Adan: None. S. Seidu: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Servier. Board Member; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Amgen, Lilly Diabetes, Merck Sharp & Dohme Corp. K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. F. Zaccardi: Speaker’s Bureau; Self; Napp Pharmaceuticals. C.L. Gillies: None. R. Lubwama: Employee; Self; Sanofi US. A.H. Boss: Employee; Self; Sanofi. Stock/Shareholder; Self; Novo Nordisk Inc., Sanofi. T.A. Dex: Consultant; Self; Sanofi US. Stock/Shareholder; Self; Bayer Healthcare Pharmaceuticals Inc., Pfizer Inc., Teva Pharmaceutical Industries Ltd.