Use_of_Rescue_Insulin_Supplement_07.12.23_clean.pdf (562.36 kB)

The Use of Rescue Insulin in the Glycemia Reduction Approaches in Diabetes (GRADE) Study

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posted on 2023-11-29, 20:22 authored by Priscilla A Hollander, Heidi Krause-Steinrauf, Nicole M. Butera, Erin J. Kazemi, Andrew J. Ahmann, Basma N Fattaleh, Mary L. Johnson, Tina Killean, Violet S Lagari, Mary E. Larkin, Elizabeth A Legowski, Neda Rasouli, Holly J Willis, Catherine L. Martin

OBJECTIVE

To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study.

RESEARCH DESIGN AND METHODS

GRADE participants (type 2 diabetes <10 years, baseline A1C 6.8% to 8.5% on metformin monotherapy, N=5,047) were randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin and followed quarterly for a mean of 5 years. Rescue insulin (glargine or aspart) was to be started within 6 weeks of A1C >7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey.

RESULTS

Nearly one-half of GRADE participants (N=2,387, 47.3%) met the threshold for rescue insulin. Among participants assigned to glimepiride, liraglutide, or sitagliptin, rescue glargine was added by 69% (39% within 6 weeks). Rescue aspart was added by 44% of glargine-assigned participants (19% within 6 weeks), and by 30% of non-glargine assigned participants (14% within 6 weeks). Higher A1C values were associated with adding rescue insulin. Intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin were among the most common reasons reported for not adding rescue insulin within 6 weeks.

CONCLUSIONS

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 non-insulin 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.