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Lookup NU author(s): Emeritus Professor Philip Home
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OBJECTIVEIndividualization of therapy choices requires the prediction of likely response. Predictor and explanatory factors of change in HbA(1c) were studied using data from a large observational study of starting insulin analog therapy (the A(1)chieve study).RESEARCH DESIGN AND METHODSUnivariate analyses were performed for insulin-naive people and prior insulin users in the A(1)chieve study. Statistically significant factors were carried forward to baseline factor-only multivariate analyses (predictor analysis), and separately using all significant factors (explanatory analysis). Power was considered in terms of the variance explained.RESULTSGeographical region, baseline HbA(1c) level, lipid levels, and baseline insulin dose were the most powerful predictors of HbA(1c) change (mean change -2.1% [-23 mmol/mol]) observed in the univariate analysis (r(2) > 0.010, P < 0.001). However, although the predictor and explanatory multivariate models explained 62-82% of the variance in HbA(1c) change, this was mainly associated with baseline HbA(1c) (r(2) = 0.544-0.701) and region (r(2) = 0.014-0.037). Other factors were statistically significant but had low predictive power (r(2) < 0.010); in the explanatory analysis, this included end-of-study hypoglycemia (insulin-naive group), insulin dose, and health-related quality of life (r(2) < 0.001-0.006, P 0.007).CONCLUSIONSMany factors can guide clinicians in predicting the response to starting therapy with insulin analogs, but many are interdependent and thus of poor utility. The factor explaining most of the variance in HbA(1c) change is baseline HbA(1c) level, with each increase of 1.0%-units (11 mmol/mol) providing a 0.7-0.8%-units (8-9 mmol/mol) greater fall. Other factors do not explain much of the remaining variance, even when including all end-of-trial measures.
Author(s): Home PD, Shen CD, Hasan MI, Latif ZA, Chen JW, Galvez GG
Publication type: Article
Publication status: Published
Journal: Diabetes Care
Print publication date: 01/05/2014
Acceptance date: 02/04/2014
ISSN (print): 0149-5992
ISSN (electronic): 1935-5548
Publisher: American Diabetes Association
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