Shenzhen "TRIO" study: clinical characteristics and effective managements of type 2 diabetic patients with initiating basal insulin therapy in Shenzhen

Objective To investigate the clinical characteristics and effective management of type 2 diabetic patients with initiating basal insulin therapy in Shenzhen. Methods A total of 4 535 patients in 4 hospitals from April 2014 to December 2017 were enrolled in "The Basic Insulin Clinical Standardized Use and Effective Management Program" in Shenzhen (Shenzhen "TRIO" Study). The program was managed by project nurses, patients were providedby standardized education at first day, and followed up with optimized management and supervision for 12 weeks. Fasting blood glucose (FPG) levels were monitored as an optimization evaluation index in the program. At the end of the follow-up, FPG levels from 4 089 patients were examined at least once. We compared our early data (from April 2014 to April 2015) from Shenzhen "TRIO" Study with the data from national "TRIO" Study, and the later data (from May 2015 to December 2017) from Shenzhen "TRIO" Study. Results Compared with national "TRIO" Study, the type 2 diabetic patients in early Shenzhen "TRIO" Study had similar age, diabetes duration and baseline FPG (all P>0.05), but there was significantly higher percentage of patients who were treated with oral anti-diabetic drugs only in Shenzhen study (69.6% (335/510) vs 51.6% (38 964/75 467), χ2=65.612, P<0.05). At the end of follow-up, the average FPG levels in patients were lower in Shenzhen study [(6.5±1.8) vs 6.91 mmol/L, t=5.377, P<0.05], and the FPG control rateswere higher (78.9% (358/454) vs 62.6% (40 334/64 420), χ2=50.879, P<0.05). Compared with the baseline data in early Shenzhen "TRIO" Study, the patients from late Shenzhen Study hadyounger age [(53.0±13.6) vs (55.6±14.2) years, t=4.094, P<0.05], higher FPG levels and HbA1c [(12.8±4.8) vs (10.9±4.2) mmol/L, (10.3±2.2)% vs (9.5±2.4)%, t=8.583, 3.661, all P<0.05]. At the end of follow-up, the average FPG levels were lower [(6.2±1.3) vs (6.5±1.8) mmol/L, t=3.661, P<0.05], and the FPG control rates were higher (84.9% (3 085/3 635) vs 78.9% (358/454), χ2=10.976, P<0.05). Conclusions The type 2 diabetic patients in Shenzhen who needed basic insulin initiation treatment had a poor blood glucose control after active oral anti-diabetic treatment. Which indicating clinical inertia the time of initiating insulin was delayed. After the optimized management led by nurses, the FPG control rates were significantly improved. The study suggests that specialist nurses play an active role in the management of type 2 diabetic patients in Shenzhen. Key words: Diabetes mellitus, type 2; Basal insulin; Fasting blood glucose; TRIO program