Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study

• Main Authors: Chen P, Ma X, Chen H, Wang K, Zhou L
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-08-01
• Series: Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy
• Subjects: type 2 diabetes mellitus; therapeutic inertia; delayed insulin initiation; glycemic control; hba1c
• Online Access: https://www.dovepress.com/delays-in-insulin-initiation-among-patients-with-type-2-diabetes-melli-peer-reviewed-article-DMSO

Pin Chen,1 Xiao Ma,2 Hong Chen,2 Ke Wang,2 Li Zhou2 1Department of Endocrinology, 900 Hospital of the Joint Logistics Team, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, People’s Republic of China; 2Lilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaCorrespondence: Li ZhouLilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaEmail [e-mail]: To describe the extent of delays in insulin initiation, analyze its impact on glycemic control, and explore factors influencing delayed insulin initiation among Chinese type 2 diabetes mellitus (T2DM) patients.Methods: A real-world, retrospective cohort study with regional electronic health records from Fuzhou, southeast China was conducted among T2DM patients. Adult patients uncontrolled with oral antidiabetic drugs (OADs; HbA1c ≥ 7%) and initiated on insulin treatment were included. Time to insulin initiation was described. After propensity-score matching, Wilcoxon rank-sum test and chi-square test were used to compare follow-up HbA1c (first HbA1c 3 months after insulin initiation) between timely (initiated insulin within 6 months after OAD failure) and delayed (initiated after 6 months) insulin-initiation groups. Sensitivity analysis was also performed by linear and logistic regression. Factors associated with delayed insulin initiation were explored using logistic regression.Results: A total of 940 patients were included, with mean±SD age 66.3± 11.9 years. In sum, 328 had HbA1c recorded 3 months after insulin initiation. After propensity-score matching (1:1 matching), 184 patients were included for further analysis. Median follow-up HbA1c was lower in the timely-initiation group than the delayed-initiation group (7.25% vs 8.25%, P=0.009). Patients in the timely initiation group also had higher odds of achieving HbA1c < 7% (OR=3.15, P=0.001). Results were confirmed by logistic regression. Hypertension, coronary artery disease, baseline HbA1c, and hospital level at insulin initiation were associated with delays in insulin initiation.Conclusion: Timely insulin initiation after OAD failure is associated with better glycemic control.Keywords: type 2 diabetes mellitus, therapeutic inertia, delayed insulin initiation, glycemic control, HbA1c