The Use of Rescue Insulin in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
Authors' conclusion
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 noninsulin 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.
Study context
- Population
- T2D duration <10 years, baseline A1C 6.8%-8.5% on metformin monotherapy; followed quarterly for a mean of 5 years
- Participants
- 5,047 participants
- Comparison
- Rescue insulin use across assigned treatments
Methodological detailsRescue insulin (glargine or aspart) to be started within 6 weeks of A1C >7.5%, confirmed
- Rescue insulin (glargine or aspart) to be started within 6 weeks of A1C >7.5%, confirmed
Primary result
As reported in the abstract
Met the threshold for rescue insulin
N = 2,387
47.3%
Rescue glargine added, glimepiride, liraglutide or sitagliptin assigned
69%
39% within 6 weeks
Rescue aspart added, glargine assigned
44%
19% within 6 weeks
Rescue aspart added, non-glargine assigned
30%
14% within 6 weeks
Further findings
Reasons for not adding rescue insulin within 6 weeks (staff-completed survey)
- Most common reasons: intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin
Original publication
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