Change in Insulin Dose and HbA1c by Geographical Region—Results from the Diabetes Unmet Need with Basal Insulin Evaluation (DUNE) Study
Authors: MAURICIO DIDAC , MENEGHINI LUIGI , ORSI EMANUELA , KLIMONTOV VADIM , WESTERBACKA JUKKA , MELAS-MELT LYDIE , PILORGET VALERIE , PERFETTI RICCARDO , KHUNTI KAMLESH 
Published: June 2018

DUNE, a 12-week, prospective, observational study (Feb 2015–Jul 2016) of 3139 people with T2DM, either newly (at enrollment) or recently (&lt;12 months, mean 5.7 months) initiated on basal insulin (BI), aimed to assess the impact of symptomatic hypoglycemia on individualized HbA1c target achievement. Only 27.9% and 26.8% of newly and recently initiated participants, respectively, achieved individualized HbA1c targets. This analysis investigated the regional variations in BI dose and HbA1c change from baseline, which may help characterize treatment practices associated with improved target achievement. Mean baseline daily BI dose across regions ranged from 0.14 to 0.21 U/kg for newly initiated and 0.25 to 0.39 U/kg for recently initiated participants. Mean baseline HbA1c ranged from 8.94 to 9.44% (newly initiated), and 8.39 to 8.78% (recently initiated) across regions. In general, HbA1c reductions were greater in newly vs. recently initiated participants, and accompanied by greater increases in daily insulin dose (Figure), except in Nordic Europe, where HbA1c reductions were similar despite a ∼3-fold difference between groups in BI dose increases from baseline. These results show that the relationship between BI dose increase and HbA1c reduction can be variable, potentially reflecting regional differences in practices or populations that warrant further analysis.

Disclosure
D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. E. Orsi: None. V. Klimontov: None. J. Westerbacka: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. L. Melas-Melt: Consultant; Self; Sanofi. V. Pilorget: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. R. Perfetti: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. K. Khunti: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Sanofi-Aventis, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Sanofi-Aventis, Pfizer Inc.. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; Novo Nordisk A/S. Consultant; Self; Pfizer Inc.. Research Support; Self; Novo Nordisk A/S.