Relationship of baseline HbA1c and HbA1c reduction following insulin therapy in Type 2 diabetes.

摘要

We read with interest the article by DeFronzo et al.[1] describing the positive relationship between baseline HbA_(1c) levels and the magnitude of HbA_(1c) change across 10 categories of glucose-lowering drugs. Their findings support and extend earlier data [2], suggesting that the baseline glycaemic status of patients with Type 2 diabetes influences the HbA_(1c) reduction in controlled clinical trials following pharmacological intervention. The level of this relation may vary from R~2 = 0.18 in the study of Bloomgarden et al. [2] to R~2 = 0.31 in the study of DeFronzo et al. [1] and may be attributable to the different clinical trials included in the analyses. The suggestion of the authors is to consider this relationship while assessing the clinical efficacy of diabetes therapies derived from clinical trials, especially as the mean baseline HbA_(1c) levels of clinical trial participants has fallen significantly over the past decade. The analysis of DeFronzo et al. [1] goes a step further, as it also includes clinical trials with insulin, incretin mimetics and an amylinomimetic, while other analyses were limited to oral drugs only [2,3].