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A multinational observational study assessing insulin use: Understanding the determinants associated with progression of therapy
Author(s) -
Ray Kausik K.,
Kendall David M.,
Zhao Zhenxiang,
Peng Xiaomei,
Caballero A. Enrique,
Polonsky William H.,
Nordstrom Beth L.,
Fan Ludi,
Curtis Bradley H.,
Davies Melanie J.
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13622
Subject(s) - medicine , insulin , diabetes mellitus , observational study , regimen , type 2 diabetes , specialty , cohort , glycemic , family medicine , endocrinology
Aims To describe global patterns of insulin treatment and to assess the impact of patient, provider, health system and economic influences on treatment decisions for patients with insulin‐treated type 2 diabetes (T2D). Methods This prospective cohort study of insulin‐treated patients with T2D was conducted across 18 countries categorized as high, upper‐middle or lower‐middle income regions. Information collected from patients included knowledge of diabetes, experiences and interactions with their healthcare provider. Physician information included specialty, practice size, availability of diabetes support services, volume of diabetes patients treated and time spent per patient. Physicians determined an individualized haemoglobin A1c (HbA1c) target for each patient by the start of the study. Changes in T2D therapies and HbA1c were recorded for 2 years. Results Complete treatment data were available for 2528 patients. Median age was 61 years and median duration of diabetes was 11.4 years. Changes to treatment regimen occurred in 90.0% of patients, but changes were less common in countries with a higher economic status ( P < 0.001). Most treatment changes involved insulin, with changes in dose the most common. Overall predictors of change in insulin therapy included younger age, use of any insulin regimen other than basal only, higher mean baseline HbA1c and longer duration of T2D. HbA1c levels remained constant regardless of regional economic status. At baseline, 20.6% of patients were at their HbA1c target; at 2 years this was 26.8%. Conclusions Among insulin‐treated patients with T2D, treatment changes were common; however, only approximately one‐fourth of individuals achieved their HbA1c target.