Identifying patients with type 2 diabetes in which basal supported oral therapy may not be the optimal treatment strategy

- Predictors for discontinuation of basal supported oral therapy in type 2 diabetes patients.
- Data from the German DIabetes Versorgungs-Evaluation (DIVE) registry.
- Higher BMI, shorter diabetes duration, and higher HbA1c predict BOT failure.

BackgroundBasal insulin supported oral therapy (BOT) can greatly improve glycaemic control; however, it may not be an optimal treatment for every patient. The identification of patient-related characteristics that may predict a switch of the treatment strategy away from BOT after originally initiating it, would be useful when deciding on treatment strategies clinically.MethodsData from the German DIabetes Versorgungs-Evaluation (DIVE) registry were analysed for patients treated with BOT for at least 3 months. BOT discontinuation was defined as the cessation of oral therapy, of insulin therapy, or the addition of short-acting insulin. Risk quantification for demographics, glycaemic control, and treatment characteristics of patients were based on Cox proportional hazards regression.ResultsBOT discontinuation occurred in 2021 patients (35.7%) of the 5663 that fulfilled the inclusion criteria for the study. Of these, 46.7% discontinued oral therapy, 32.7% discontinued insulin, and 20.6% had short-acting insulin added to their treatment. Multivariate analysis revealed that higher body mass index (BMI; hazard ratio, HR: 1.012; 95% CI: 1.001-1.023; p = 0.029), shorter diabetes duration (HR: 0.982; 95% CI: 0.976-0.989; p < 0.001), and higher HbA1c level (HR: 1.102; 95% CI: 1.022-1.188; p = 0.011) were associated with BOT discontinuation.ConclusionsIdentification of factors that may be predictive of a discontinuation of BOT could be highly useful in a clinical setting when assessing the most appropriate treatment strategy for type 2 diabetes patients.