Time in uncontrolled hyperglycemia before insulin initiation in people living with type 2 diabetes: A systematic literature review
Bibliographic record
Abstract
BackgroundThis systematic literature review (PROSPERO registration: CRD42022327974) examined the duration of uncontrolled hyperglycemia (glycated hemoglobin [HbA1c] ≥ 7.0%; ≥ 53 mmol/mol) before basal insulin initiation in insulin-naive people with type 2 diabetes who were receiving concomitant oral glucose-lowering agents or injectable glucagon-like peptide-1 receptor agonist therapy.MethodsDatabases (Embase and MEDLINE) were searched to identify relevant articles published between January 1, 2001, and April 19, 2023. Supplementary searches were completed for relevant congresses between 2018 and 2023.ResultsOf the 4260 de-duplicated publications identified, 18 eligible publications (conducted in: Europe, n = 5; USA, n = 8; Asia/Middle East, n = 4; and Africa, n = 1) reported time spent with HbA1c 7.0% or higher (≥ 53 mmol/mol). Overall, time in uncontrolled hyperglycemia ranged from 1.9 months to 86.4 months (Europe, 9.0–86.4 months; USA, 1.9–58.3 months; Asia/Middle East, 3.3–40.1 months; Africa, 36 months).ConclusionsThere is a widespread delay in insulin treatment initiation in clinical practice. This delay exists despite availability of novel insulin types and the development of evidence-based treatment guidelines, suggesting that further efforts are needed to improve implementation of these guidelines in clinical practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".