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Predictors of HbA1c over 4 years in people with type 2 diabetes starting insulin therapies: The CREDIT study

Lookup NU author(s): Emeritus Professor Philip Home



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Aims: To identify factors associated with glucose control, as measured by HbA1c over 4 years, in people with type 2 diabetes starting insulin therapy.Methods: CREDIT, an observational cohort study, collected data semi-annually over 4 years, on people with type 2 diabetes starting any insulin, in 311 centres in 12 countries; 2803 people had data on HbA1c during follow-up. Multivariable backward regression analysis selected characteristics associated with glycaemic control from a limited number of candidate variables.Results: Before starting insulin therapy, HbA1c was 9.3% (78 mmol/mol) and decreased to 7.6% (60 mmol/mol) after 1 year, and changed little after that. Insulin dose increased from 0.21 U/kg to 0.36 U/kg at 1 year, and then by 0.10 U/kg over the next 3 years. Body weight increased by 2.0 kg in the first year and increased little thereafter. Poorer glycaemic control over the 4 years was mainly determined by the HbA1c before starting therapy, after accounting for the other statistically significant associated variables in multivariable analysis: higher BMI, younger age, longer diabetes duration, more glucose-lowering drugs, using basal insulin alone, higher insulin dose and female sex. At 4 years, a higher current insulin dose was the characteristic most strongly associated with a higher concurrent HbA1c.Conclusions: HbA1c at the start of insulin therapy was the characteristic most predictive of later HbA1c, after accounting for other variables associated with HbA1c. This may provide some justification for earlier insulin introduction to improve glucose control to target. (c) 2015 The Authors. Published by Elsevier Ireland Ltd.

Publication metadata

Author(s): Balkau B, Calvi-Gries F, Freemantle N, Vincent M, Pilorget V, Home PD

Publication type: Article

Publication status: Published

Journal: Diabetes Research and Clinical Practice

Year: 2015

Volume: 108

Issue: 3

Pages: 432-440

Print publication date: 01/06/2015

Online publication date: 12/03/2015

Acceptance date: 28/02/2015

Date deposited: 20/05/2016

ISSN (print): 0168-8227

ISSN (electronic): 1872-8227

Publisher: Elsevier


DOI: 10.1016/j.diabres.2015.02.034


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