{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:27:41Z","timestamp":1765546061934},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,3,25]],"date-time":"2016-03-25T00:00:00Z","timestamp":1458864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"BRIDGES"},{"name":"International Diabetes Federation"},{"name":"Diabetes Care System"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To identify HbA<jats:sub>1c<\/jats:sub> trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (<jats:italic>n<\/jats:italic> = 9849). Inclusion criteria were: age \u2265 40 years; initiation of insulin during follow\u2010up after failure to reach HbA<jats:sub>1c<\/jats:sub> levels \u2264 53 mmol\/mol (7%) with oral glucose\u2010lowering agents; and a follow up \u2265 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA<jats:sub>1c<\/jats:sub>. Subjects considered to be \u2018off target\u2019 had HbA<jats:sub>1c<\/jats:sub> levels \u2265 53 mmol\/mol (7.0%) during one\u2010third or more of the follow\u2010up time, and those considered to be \u2018on target\u2019 had HbA<jats:sub>1c<\/jats:sub> levels \u2265 53 mmol\/mol (7.0%) during less than one\u2010third of the follow\u2010up time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four HbA<jats:sub>1c<\/jats:sub> trajectories were identified. Most people (88.7%) were classified as having a stable HbA<jats:sub>1c<\/jats:sub> trajectory of ~57 mmol\/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA<jats:sub>1c<\/jats:sub> levels and a higher age at the start of insulin treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using latent class growth modelling, four HbA<jats:sub>1c<\/jats:sub> trajectories were identified. A quarter of the people starting insulin were on target. Low HbA<jats:sub>1c<\/jats:sub> levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13110","type":"journal-article","created":{"date-parts":[[2016,3,6]],"date-time":"2016-03-06T07:51:56Z","timestamp":1457250716000},"page":"794-802","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System"],"prefix":"10.1111","volume":"33","author":[{"given":"M. R.","family":"Mast","sequence":"first","affiliation":[{"name":"EMGO Institute for Health and Care Research VU University Amsterdam The Netherlands"},{"name":"Department of Clinical Pharmacology and Pharmacy VU University Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Walraven","sequence":"additional","affiliation":[{"name":"EMGO Institute for Health and Care Research VU University Amsterdam The Netherlands"},{"name":"Department of Epidemiology and Biostatistics VU University Amsterdam The Netherlands"},{"name":"Department of Ophthalmology VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Hoekstra","sequence":"additional","affiliation":[{"name":"EMGO Institute for Health and Care Research VU University Amsterdam The Netherlands"},{"name":"Department of Epidemiology and Biostatistics VU University Amsterdam The Netherlands"},{"name":"Department of Health Sciences Faculty of Earth and Life Sciences VU University Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. P. D.","family":"Jansen","sequence":"additional","affiliation":[{"name":"EMGO Institute for Health and Care Research VU University Amsterdam The Netherlands"},{"name":"Department of General Practice and Elderly Care Medicine VU University Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. A. W. A.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"EMGO Institute for Health and Care Research VU University Amsterdam The Netherlands"},{"name":"Department of General Practice and Elderly Care Medicine VU University Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. J. 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