Effect of Baseline Glycosylated Hemoglobin A1c on Glycemic Control and Diabetes Management Following Initiation of Once-Daily Insulin Detemir in Real-Life Clinical Practice

Endocr Pract. May-Jun 2013;19(3):462-70. doi: 10.4158/EP12269.OR.


Objective: The SOLVE study investigated the initiation of basal insulin in patients with type 2 diabetes on oral antidiabetic (OAD) treatment and outcomes in patients with varying levels of glycemic control at baseline.

Methods: This was an observational cohort study conducted in 10 countries using insulin detemir. Data were collected at 3 clinic visits (baseline, 12-week interim, and 24-week final visit).

Results: A total of 13,526 (77.9%) patients were included in the glycosylated hemoglobin A1c (HbA1c) subset analysis. Patients were grouped according to pre-insulin HbA1c values as follows: HbA1c <7.6% (n = 2,797); HbA1c 7.6-9% (n = 5,366), and HbA1c >9% (n = 5,363). A total of 27 patients experienced serious adverse drug reactions (SADRs) and/or severe hypoglycemia (3, 10, and 11 patients with pre-insulin HbA1c <7.6%, 7.6-9.0%, and >9.0%, respectively). All patient subgroups realized improvements in HbA1c, with the pre-insulin HbA1c >9% subgroup having the largest HbA1c reduction (-2.4% versus -0.9% and -0.2% for HbA1c subgroups 7.6-9% and <7.6%, respectively). In the total cohort (n = 17,374), the incidence of severe hypoglycemia decreased from 4 events per 100 person years to <1 event per 100 person years by final visit; the incidence of minor hypoglycemia increased from 1.6 to 1.8 events per person year.

Conclusions: In this study, insulin initiation was delayed until late in disease course, and overall concordance with internationally recognized guidelines was low. The initiation of once-daily insulin detemir was associated with substantial improvements in glycemic control and was not associated with an increase in severe hypoglycemia or weight gain.

MeSH terms

  • Aged
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism*
  • Drug Administration Schedule
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Insulin Detemir
  • Insulin, Long-Acting / administration & dosage*
  • Insulin, Long-Acting / therapeutic use*
  • Male
  • Middle Aged


  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin, Long-Acting
  • Insulin Detemir