Determinants of successful glycemic control among participants in the BARI 2D Trial: A Post-hoc Analysis

Faramarz Ismail-Beigi, Manuel S. Lombardero, Jorge Escobedo, Saul Genuth, Jennifer Green, Elaine Massaro, Arshag D. Mooradian, Fernando Ovalle, Fred Whitehouse, Joel Zonszein

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalJournal of Diabetes and its Complications
Volume28
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Insulin
Logistic Models
Therapeutics
Research Design
Cardiovascular Diseases

Keywords

  • Cardiovascular disease
  • Plasma insulin levels
  • Predictors of glycemic control

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Medicine(all)

Cite this

Determinants of successful glycemic control among participants in the BARI 2D Trial : A Post-hoc Analysis. / Ismail-Beigi, Faramarz; Lombardero, Manuel S.; Escobedo, Jorge; Genuth, Saul; Green, Jennifer; Massaro, Elaine; Mooradian, Arshag D.; Ovalle, Fernando; Whitehouse, Fred; Zonszein, Joel.

In: Journal of Diabetes and its Complications, Vol. 28, No. 1, 01.2014, p. 101-109.

Research output: Contribution to journalArticle

Ismail-Beigi, F, Lombardero, MS, Escobedo, J, Genuth, S, Green, J, Massaro, E, Mooradian, AD, Ovalle, F, Whitehouse, F & Zonszein, J 2014, 'Determinants of successful glycemic control among participants in the BARI 2D Trial: A Post-hoc Analysis', Journal of Diabetes and its Complications, vol. 28, no. 1, pp. 101-109. https://doi.org/10.1016/j.jdiacomp.2013.01.006
Ismail-Beigi, Faramarz ; Lombardero, Manuel S. ; Escobedo, Jorge ; Genuth, Saul ; Green, Jennifer ; Massaro, Elaine ; Mooradian, Arshag D. ; Ovalle, Fernando ; Whitehouse, Fred ; Zonszein, Joel. / Determinants of successful glycemic control among participants in the BARI 2D Trial : A Post-hoc Analysis. In: Journal of Diabetes and its Complications. 2014 ; Vol. 28, No. 1. pp. 101-109.
@article{feef94bab46b4dc0abd5118ff1cad79b,
title = "Determinants of successful glycemic control among participants in the BARI 2D Trial: A Post-hoc Analysis",
abstract = "Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0{\%} after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80{\%} of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.",
keywords = "Cardiovascular disease, Plasma insulin levels, Predictors of glycemic control",
author = "Faramarz Ismail-Beigi and Lombardero, {Manuel S.} and Jorge Escobedo and Saul Genuth and Jennifer Green and Elaine Massaro and Mooradian, {Arshag D.} and Fernando Ovalle and Fred Whitehouse and Joel Zonszein",
year = "2014",
month = "1",
doi = "10.1016/j.jdiacomp.2013.01.006",
language = "English (US)",
volume = "28",
pages = "101--109",
journal = "Journal of Diabetes and its Complications",
issn = "1056-8727",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Determinants of successful glycemic control among participants in the BARI 2D Trial

T2 - A Post-hoc Analysis

AU - Ismail-Beigi, Faramarz

AU - Lombardero, Manuel S.

AU - Escobedo, Jorge

AU - Genuth, Saul

AU - Green, Jennifer

AU - Massaro, Elaine

AU - Mooradian, Arshag D.

AU - Ovalle, Fernando

AU - Whitehouse, Fred

AU - Zonszein, Joel

PY - 2014/1

Y1 - 2014/1

N2 - Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.

AB - Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.

KW - Cardiovascular disease

KW - Plasma insulin levels

KW - Predictors of glycemic control

UR - http://www.scopus.com/inward/record.url?scp=84891832594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891832594&partnerID=8YFLogxK

U2 - 10.1016/j.jdiacomp.2013.01.006

DO - 10.1016/j.jdiacomp.2013.01.006

M3 - Article

C2 - 23478173

AN - SCOPUS:84891832594

VL - 28

SP - 101

EP - 109

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

SN - 1056-8727

IS - 1

ER -