Time to insulin initiation and long-term effects of initiating insulin in people with type 2 diabetes mellitus: the Hoorn Diabetes Care System Cohort Study. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Mast, Ruth; Danielle Jansen, A P; Walraven, Iris; Rauh, Simone P; van der Heijden, Amber A W A; Heine, Robert J; Elders, Petra J M; Dekker, Jacqueline M; Nijpels, Giel; Hugtenburg, Jacqueline G
• Is Part Of: European journal of endocrinology. Volume 174:Issue 5(2016)
• Page Start: 563
• Page End: 571
• Publication Date: 2016-05
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-15-1149
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract : Objective: The aim of this study was to assess the time to insulin initiation in type 2 diabetes mellitus (T2DM) patients treated with oral glucose-lowering agents and to determine the baseline characteristics associated with time to insulin initiation. This was evaluated in T2DM patients with HbA1c levels consistently ≥7.0% during total follow up and in those with fluctuating HbA1c levels around 7.0%. Design and methods: Prospective, observational study was performed, comprising 2418 persons with T2DM aged ≥40 years who entered the Diabetes Care System between 1998 and 2012 with a minimum follow up of at least 3 years, following the first HbA1c level ≥7.0%. Cox regression analyses were performed to assess the determinants of time to insulin initiation. Data related to long-term effects of insulin initiation were studied at baseline and at the end of follow up using descriptive summary statistics. Results: Two-thirds of the patients initiated insulin during follow up. The time to insulin varied from 1.2 years (range 0.3–3.1) in patients with HbA1c levels consistently ≥7.0% to 5.4 years (range 3.0–7.5) in patients with fluctuating HbA1c levels around 7.0%. Longer diabetes duration (hazard ratio (HR) 1.04 95% CI 1.03–1.05) and lower age (HR 1.00 95% CI 0.99–1.00) at baseline were associated with a shorter time to initiation. More insulin initiators had retinopathy compared with patients that remained on oral glucose-lowering agents during follow up. Conclusion: The time to insulin initiation was short, and most of the patients with HbA1c levels consistently ≥7.0% were initiating insulin. Longer diabetes duration and younger age shortened the time to insulin.