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Predictors and consequences of declining insulin therapy by individuals with type 2 diabetes
Author(s) -
Turchin A.,
Hosomura N.,
Zhang H.,
Malmasi S.,
Shubina M.
Publication year - 2020
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14260
Subject(s) - medicine , insulin , diabetes mellitus , type 2 diabetes , hazard ratio , type 1 diabetes , endocrinology , confidence interval
Aim To determine the relationship between decline of insulin therapy by individuals with type 2 diabetes and subsequent blood glucose control. Methods We retrospectively studied adults with type 2 diabetes and suboptimal (HbA 1c ≥ 53 mmol/mol [7.0%]) glycaemic control followed at two academic hospitals between 2000 and 2014 who were recommended insulin therapy. Decline of insulin therapy recommendations was identified using natural language processing of provider notes. Time to HbA 1c < 53 mmol/mol (7.0%) served as the primary outcome. Results Of 5307 study participants, 2267 (42.7%) declined insulin therapy. Median time to HbA 1c control in individuals who declined vs. started insulin therapy was 50 vs. 38 months, respectively ( P < 0.001). In multivariable analysis, decline of insulin therapy was associated with hazard ratio for HbA 1c control of 0.89 (95% CI 0.82 to 0.97; P = 0.008). Participants were more likely to accept insulin therapy recommendations if they had diabetes complications (OR 1.32; 95% CI 1.13 to 1.53; P < 0.001) or a higher HbA 1c (OR 1.10; 95% CI 1.07 to 1.13; P < 0.001), and less likely if they were older (OR 0.81; 95% CI 0.76 to 0.86; P < 0.001) or were taking more non‐insulin diabetes medications (OR 0.78; 95% CI 0.74 to 0.83; P < 0.001). Conclusions Individuals with uncontrolled type 2 diabetes who declined insulin therapy subsequently had worse glycaemic control. These findings highlight the need to improve our understanding of the relationship of this common but poorly explored clinical phenomenon to blood glucose control and ultimately diabetes complications.