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72
VOLUME 9 NUMBER 2 • JUNE 2012
REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
I
mproving glucose control and quality of life for type 2 diabetes
patients demands clinical acumen and the timely introduction
of or switching to analogue insulin therapies. The A
1
chieve
study was an observational study across four continents (Asia,
Africa, Latin America and Europe), to assess insulin usage in clinical
practice, particularly evaluating effectiveness in terms of HbA
1c
, fasting plasma glucose (FPG) and postprandial plasma glucose
(PPG) levels, and patient quality of life.
A focus on developing countries
An important aim was to remedy the deficit of data on the efficacy
and safety of insulin analogues in routine clinical care in less well-
resourced or newly developed countries. The baseline data from
the 66 000 patients recruited in A
1
chieve
1
shows the depth of the
unmet clinical need in diabetes management in everyday practice.
Overall baseline HbA
1c
control was poor, at 9.5 ± 1.8%.
Diabetes duration among insulin-naïve patients was 6.6 years,
while prior insulin users had a diabetes history of 10.8 years.
There were slightly more men than women; 55% were male.
Prior oral glucose therapy included metformin, sulfonylureas and
thiazolidinediones.
Baseline HbA
1c
level was similar in all regions, whether prior
insulin treated or not, with the Latin American region showing
the highest (9.9%), and South Asia the lowest (9.3%) levels.
Achieving improved glucose control and quality of life with
analogue insulins
A
1
chieve study in everyday clinical practice
JULIA AALBERS
Insulin-experienced people were somewhat older than the insulin-
naïve cohort (55.6 vs 53.2 years) and had a higher body mass
index (BMI).
Study design
In the study of six months’ duration, clinicians were not subjected
to defined study-related criteria and were free to use any insulin
or treatment, but patients inclued in this study were started on
Novomix
®
30, NovoRapid
®
and Levemir
®
as local practice dictated.
This is important as it reflects daily clinical practice unrelated to
clinical trial definitions. The final results from A
1
chieve were unveiled
at the International Diabetes Federation (IDF) Watch diabetes
congress in Dubai, 4–8 December 2011.
Improved blood glucose control
Blood glucose control improved markedly between baseline and six
months in both the insulin-naïve and prior insulin-user groups on
therapy with analogue insulins. After six months, the percentage of
patients with an HbA
1c
level below 7% increased dramatically from
4 to 32%. Reduction of use of oral glucose-lowering drugs was
evident in both insulin-naïve and -experienced regimens. In-depth
analysis of insulin usage and control highlighted interesting data
pertinent to everyday practice.
1
Fig. 1.
Baseline and week 24 mean HbA
1c
level (%) in those patients adding
insulin aspart to a basal insulin.
Fig. 2.
Baseline and week 24 mean FPG (mmol/l) and PPG levels (mmol/l) in
those patients adding insulin aspart to a basal insulin.
S Afr J Diabetes Vasc Dis
2012;
9
: 72–74