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Delayed initiation of subcutaneous insulin therapy after failure of oral glucose‐lowering agents in patients with Type 2 diabetes: a population‐based analysis in the UK
Author(s) -
Rubino A.,
McQuay L. J.,
Gough S. C.,
Kvasz M.,
Tennis P.
Publication year - 2007
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/j.1464-5491.2007.02279.x
Subject(s) - medicine , insulin , diabetes mellitus , type 2 diabetes , population , type 1 diabetes , concomitant , cohort , retrospective cohort study , dose , surgery , pediatrics , endocrinology , environmental health
Aims The aim of this retrospective cohort study was to estimate the time to insulin initiation in patients with Type 2 diabetes inadequately controlled on oral glucose‐lowering agents (OGLAs). Methods Insulin‐naïve patients failing on OGLAs were identified from The Health Improvement Network database, which collects records from general practices throughout the UK. Patients were included if they were aged ≥ 40 years, had concomitant prescriptions for ≥ 2 OGLAs, and ≥ 1 year of available records prior to the first occurrence of HbA 1c ≥ 8.0% after ≥ 90 days of OGLA polytherapy at ≥ 50% of maximum recommended dosages. Results A total of 2501 eligible patients with Type 2 diabetes who had an HbA 1c above the OGLA failure threshold of ≥ 8.0% were identified (54.0% male; 30.9% aged 60–69 years). It was estimated that if all the eligible patients were followed for 5 years, 25% would initiate insulin within 1.8 years of OGLA failure (95% CI 1.6–2.0), and 50% within 4.9 years (95% CI 4.6–5.8). The presence of diabetes‐related complications had no substantial impact on the time to insulin initiation. Conclusions This study found that 25% of patients with Type 2 diabetes had insulin initiation delayed for at least 1.8 years, and 50% of patients delayed starting insulin for almost 5 years after failure of glycaemic control with OGLA polytherapy, even in the presence of diabetes‐related complications. Interventions that reduce this delay to insulin initiation are required to help achieve and maintain recommended glycaemic targets in patients with Type 2 diabetes.